Increasing the Time Between Meals: Intermittent Fasting

When people think of “fasting” what comes to mind is an almost-intolerable short period of time without food, and with nothing to drink (except maybe water) and where people usually spend most of the time counting until they can eat again. This is the case when we are used to burning carbs as our fuel source and then just stop eating. Our body slows its metabolism in response to the severe calorie restriction in an effort to spare energy.  We feel cold, tired, lethargic and we find it difficult to concentrate because our body is in starvation mode.

When we are fat-adapted, we use the fat in our diet (dietary fat) and our own fat stores (endogenous fat) as our fuel source. When we “fast”, we stop supplying our body with dietary fat, so our body relies solely on our fat stores to supply its energy needs.  Most of us who are following a low carb high fat diet have plenty of endogenous fat, so when we aren’t eating, we don’t feel hungry, tired or cold because our body has a plentiful source of energy! Our basal metabolism doesn’t drop.  Rather than feeling cold and tired and finding it difficult to think, we are able to think clearly using ketones produced from fat to fuel our body, rather than glucose.

“Intermittent fasting” is simply increasing the amount of time between meals.  Fasting is not eating or rather, not eating now. It’s different than “starving” because our basal metabolic rate is being maintained through our fat stores. When we are in starvation mode, our basal metabolism drops significantly in order to spare energy – that’s why we feel cold and tired, because our body is saving calories for our brain and our heart to function. Fasting also doesn’t mean that we can’t consume anything! There are plenty of things we can have during the delay before our next meal. The most natural “intermittent fast” is the one between after supper and breakfast the next morning.  Yes, that is why it is called “breakfast”.

Why Fast?

When we eat, insulin is released in response to the presence of carbs in the food we eat and functions to (a) move glucose out of the blood and to (b) store the glucose that is not immediately needed for energy, as fat.

When we are accustomed (as most of us have been) to eating three meals a day plus having a couple of snacks, insulin is released every few hours. If we have been “grazing”, we have been constantly releasing insulin. As a result of this, our cells have become insensitive to insulin – something known as “insulin resistance“, or insulin tolerant.  To conceptualize this, think of going into a room with loud music.  At first your ears buzz and your auditory system is overwhelmed, but after a bit of time, your body adapts. It’s similar with smell.  When you’re exposed to a pungent odor, at first that’s all your can concentrate on, but after time passes, your brain starts to “tune out” the signals from your nose and you become less aware of the smell.  It’s not that the odor decreases, but our response to the odor, decreases as we become “tolerant” to that molecule bound to our olfactory receptors.

The difference with “insulin resistance” is that it is more than our body becoming “tolerant” of the circulating insulin, it actually responds less to it.

Think of someone that drinks considerable amounts of alcohol.  They can have 3 or 4 drinks and not feel intoxicated, because they have a “high tolerance” to the ethanol in the drink.  It takes more and more alcohol for them to respond. When someone is “insulin tolerant” (also called “insulin resistant”), the same amount of insulin has less and less effect, so to adapt, to be able to move the glucose out of the blood and store the excess energy as fat, the body needs to release more and more insulin. From years and years of eating 3 carb-based meals plus a couple of carb-laden snacks each day, our insulin levels simply don’t fall to baseline.

When someone is not insulin resistant, delaying the time before the next meal enables their insulin levels to fall to baseline (10-30 pMol) in approximately  12 hours, so if they don’t eat anything after dinner and their first meal of the day is breakfast the next morning, that time period is usually close to 12 hours. However, for people who are insulin resistant,  a longer time period is often needed for their insulin levels to fall to baseline. Just as insulin resistance developed over time, gradually, a new lower baseline can be set over time by increasing the length of time that one intermittently fasts.

Twelve-Hour Fast

A twelve-hour fast is the easiest one for most people to do, because during most of it, they’re asleep!

This is the one I suggest to my clients once they’re fat-adapted (usually after ~4 weeks of eating low carb high fat) as all it entails is not eating anything after supper until breakfast the next morning.

That’s it.

So, say they finish dinner at 6:30 PM, then the next time they eat is breakfast the next morning at 6:30 AM. This simple, short 12-hour “fast” is just enough to enable their insulin to fall to baseline. Doing this often, if not daily is the goal. This is entirely do-able and an important first step in restoring insulin sensitivity and it is certainly not something “radical”. Years ago, people didn’t eat after supper!

People who have Type 2 Diabetes should check with their doctor before beginning doing any form of Intermittent Fasting – and definitely should do so if they are on any kind of medication to manage their blood sugar, blood pressure or cholesterol, without having their doctors oversee it.  Medication will often need to be adjusted downward (and sometimes eventually discontinued entirely) as insulin sensitivity returns, so don’t do this without involving your doctor, first!

Eighteen Hour Fast

Once people have become used to not eating from supper until breakfast, they may want to wait to eat their first meal until noon the next day, especially if they don’t feel particularly hungry in the morning. Some people are not “breakfast” people and if they eat well the night before, they may not want to eat in the morning. An eighteen hour “fast” is from after someone has finished dinner (say, at 6:00 PM) until noon the next day.

Many do want their cup of coffee, which is totally fine provided it is unsweetened. I don’t recommend that people use sugar substitutes, especially the sugar alcohols such as sorbitol, mannitol or xylitol which have the same number of carbs per teaspoon as ordinary table sugar.

Cappuccino foamed with 1/2 oz of cream diluted with 1 oz of cold, filtered water

Cream can certainly be added to drip coffee and there’s no need to give up your morning latte or cappuccino – just a little creativity to replace the milk (which has almost as many carbs per cup as a slice of bread!).

My trick is to foam 1/2 an ounce of cream with an ounce or ounce and a half of cold, filtered water.

This makes fasting until lunch entirely possible!!

Twenty-four Hour Fast

Note: I don’t do these and I don’t recommend that my clients do these unless they are being very closely monitored by their doctor, however I want to describe them, so people know what they are.

twenty-four hour “fast” is from the end of supper one day, until the start of supper the following day (technically it is a 23-hour fast unless you add the extra hour  😯). As with the eighteen-hour fast, one can have unsweetened coffee or tea with a drop of cream, club soda (seltzer) with a twist of lime or lemon, or “bone broth”. “Bone broth” can be made from any kind of meat, fish or poultry bones, but for me, when I think of “bone broth”, I think of a wonderful, rich broth made from beef marrow bones, that is gently simmered overnight on the stove, ready to be sipped as desired, on a fast day.

To avoid getting constipated, many people will take psillium fiber with water each morning and which can be added to cups of “bone broth” or dissolved in a little bit of diluted coconut milk.

Ingredients for “bone broth” – beef marrow bones, ox feet, onion, garlic and fresh peppercorns

 

 

 

 

 

cup of beef “bone broth” – made from ingredients above

What’s not to love about sipping this when “fasting”?

 

 

 

 

 

The main purpose of delaying the time between meals (“intermittent fasting”) is to restore insulin sensitivity. When we aren’t eating, we aren’t releasing insulin – and as we continue eating low carb high fat and delaying the time between meals, our insulin receptors become sensitive to insulin once again.

Normalized blood sugar levels (both fasting blood glucose and HbA1C) is a natural byproduct, not the goal.  The goal is releasing less and less insulin in response to the food we eat and our body’s sensitivity to the insulin that we do release, being restored.

Weight loss is another added benefit!

Have questions about how I can help you? Please send me a note using the “Contact Us” form on the tab above.

you can follow me at:

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Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.


 

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What is the Anti-Inflammatory Protocol and what is it used for?

Changing how and what we eat, as well as managing stress and getting enough restful sleep has been shown in research studies to reduce pain and symptoms in people with chronic inflammatory diseases such as Rheumatoid Arthritis, Fibromyalgia, Hashimoto’s Hypothyroidism, Celiac disease, etc.. As well, there is increasing evidence that cardiovascular disease, including heart attack and stroke are inflammatory in nature and that lowering risk is best managed through dietary and lifestyle changes. For those with a strong family history of heart disease, the Anti-Inflammatory Protocol dove-tails perfectly with a low-carb high healthy fat diet.


Knowing which foods promote inflammation and why and which foods are evidence-based to have anti-inflammatory properties  and why is essential for those seeking to reduce pain and symptoms associated with a chronic inflammatory condition. Choosing foods that are nutrient dense, promote gut health, address diet-related disruptions in hormone-regulation and that target immune system regulation are key in the Anti-Inflammatory Protocol.

Nutrient density – Every system in the body, including the immune system requires an array of vitamins, minerals, antioxidants, essential fatty acids, and amino acids to function normally. Micronutrient deficiencies and imbalances are considered key players in the development and progression of autoimmune disease, therefor attention is put on consuming the most nutrient-dense foods available. A nutrient-dense diet provides the ‘building blocks’ that the body needs to heal damaged tissues. The goal is to supply the body with a surplus of micronutrients to correct both deficiencies and imbalances, supporting regulation of the immune system, hormone and neurotransmitter production.

Gut health – It is thought that ‘gut dysbiosis’ (gut microbial imbalance) and ‘leaky gut’ may be key facilitators in the development of autoimmune disease. The foods recommended on the Anti-inflammatory Protocol support the growth of healthy levels and a healthy variety of gut microorganisms. Foods that irritate or damage the lining of the gut are avoided, while foods that help restore gut barrier function and promote healing are encouraged.

Diet-related Disruptions in hormone regulation – What we eat, when we eat, and how much we eat affects a variety of hormones that interact with the immune system. Eating foods with too much sugar or ‘grazing’ throughout the day, rather than eating food at set meals spaced apart deregulate these hormones. As a result, the immune system is typically stimulated. Promoting regulation of these hormones through diet, in turn has a modulating effect on the immune system. As well, dietary hormones that impact the immune system are also profoundly affected by how much sleep we get, how much and what kinds of activity we do, and how well we reduce and manage stress, so looking at diet and lifestyle together, is key.

Immune system regulation – Our intestines are home to millions of bacteria which live in symbiotic relationship with us.  We provide food for them and when in balance, they maintain the integrity of the gut wall, which serves as a protective barrier. When our gut ‘flora’ gets out of balance, having an excess of pathogenic bacteria, this protective barrier becomes compromised, resulting in small ‘holes’ that permit exchange between the inside of our gut and the blood stream.  This is what is called “leaky gut“. Endotoxins produced by the proliferation of “bad” bacteria can get into the blood stream, stimulating the immune system, and resulting in systemic inflammation. What becomes critical is to limit the factors that contribute to excess of the “bad bacteria” and restore a healthy amount and diversity of “good” gut microorganisms, so that the gut once again functions as a protective barrier, and immune system regulation is achieved.

What is the Anti-Inflammatory Protocol?

The Anti-Inflammatory Protocol identifies foods that promote inflammation from those that research indicates have anti-inflammatory properties. It isn’t simply a list of “eat this” and “don’t eat that”, but explains what about a particular food promotes inflammation or inhibits it. It explains the role of key inflammatory -producing compounds such as lectinssaponins and protease inhibitors, and which foods they are found in, and how eating those foods contribute to “leaky gut”. Which grains can one eat?  Which should be avoided? What about beans and lentils? Are there some better than others?

The Anti-Inflammatory Protocol explains which healthy cooking and eating fats won’t contribute to the production of Advanced Glycation End-Products (AGEs) – and how this compound causes oxidative damage to the cells in the body. Knowing this enables people to know whether oils such as grapeseed for example, are a good choice and if not, why – as well as which other oils would be preferable.

I want people to understand in simple terms how omega 6 (ω-6) fats compete for binding sites and elongation enzymes with omega 3 (ω-3) fats, as this enables them to determine whether foods such as nuts and seeds should be included in an anti-inflammatory diet. If they understand the role of hormones such as insulin and what causes it’s release, they can determine for themselves whether products like agave syrup or coconut sugar are preferable to table sugar when following an anti-inflammatory protocol. I find that once people understand the theory as to why they should eat less of certain foods (explained in ways that don’t require an educational background in science!) and they also understand which types of foods they should aim to eat more of, they are empowered to make dietary choices that contribute to reducing inflammation, as well as symptoms, along with risk factors for other inflammation-related conditions.

I consider my primary role is as an educator. I don’t want to tell someone they need to eat this food on this day and this other food on the next day.  It is far more rewarding and helpful to them, if I help them know how to make these decisions themselves.

Want to know more? Why not send me a note using the “Contact Us” form above.

To our good health,

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

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Part 2: How is Insulin Resistance Measured?

The introduction to this article (Part 1: What is Insulin Resistance)  explains what insulin resistance is, the conventional treatment for it and the drawbacks to that treatment: https://www.lchf-rd.com/2017/07/26/what-is-insulin-resistance/

INTRO: There are a number of tools available for measuring insulin resistance, most of which are more suited to a research setting, including the Quantitative Insulin Sensitivity Check Index (QUICKI) and the Matsuda Index.  Others, such as the McAuley -, Belfiore -, Cederholm -, Avignon – and Stumvoll Index are better suited for epidemiological (population) research studies and are often compared to the “gold standard” for the measurement of insulin sensitivity, the Hyperinsulinemic Euglycemic Clamp (HEC).

The homeostasis model assessment (HOMA-IR) method is suitable for individuals to use with their doctors or Dietitians to assess insulin resistance, and is useful for using over time to measure the impact of dietary and lifestyle changes in lowering insulin resistance.


Visualizing Insulin Resistance

Insulin resistance can be determined by measuring insulin response to a standard glucose load over a 5 hour period and plotting the Insulin Response curves – which is precisely what Dr. Joseph R. Kraft MD, who was Chairman of the Department of Clinical Pathology and Nuclear Medicine, St. Joseph Hospital, Chicago, until his retirement.

Dr. Kraft spent more than a quarter century devoted to the study of glucose metabolism and blood insulin levels – collecting data in almost 15,000 people, aged 3 to 90 years old. Between 1972 and 1998, Dr. Kraft measured the Insulin Response and data from 10,829 of these subjects indicated that 75% of subjects were insulin resistant.

Compiling this data, five distinct Insulin Response Patterns emerged.

Pattern I

The light green curve below, is what a normal insulin response should look like. Insulin levels should rise steadily in the first 45 minutes (in response to the standard glucose load) to no higher than ~60 mIU/L (430.5 pmol/L) and then decrease steadily until baseline by 3 hours.

PATTERN II

People who are in the early stages of insulin resistance (Pattern II, represented by the yellow curve) release considerably more insulin in response to the exact same glucose load. Insulin levels rise to ~ 115 mIU/L (825 pmol/L) in the first hour and then take considerably longer (5 hrs) to drop back down to baseline, than the normal response.

PATTERN III

People who have progressed in insulin resistance to Pattern III have insulin levels that keep rising for the first 2 hours and then drop off more sharply, back down to baseline.

PATTERN IV

Those with Type 2 Diabetes / very high insulin resistance (Pattern IV) release huge amounts of insulin almost immediately, reaching levels of ~ 150 mIU/L (1076 pmol/L) at 1 hour.  Then for the next 2 hours, insulin continues to climb, before it begins to decline to baseline.  Even at 5 hours, insulin levels never decrease to normal values.

PATTERN V

Is what is seen in Type I Diabetes (T1D), when there is insufficient insulin production.

Please see Significance of Insulin Resistance for more details on Dr. Kraft's findings: https://www.lchf-rd.com/2017/03/22/featured-significance-of-insulin-resistance/

While a 5 hour glucose tolerance test is not available at most labs, a 2 hour glucose tolerance test (2hrGTT) will indicate whether or not a person is insulin resistant or Type 2 Diabetic. 

However, once a person is already diagnosed as Type 2 Diabetic, most medical plans will not cover the cost of having the test re-performed in order to determine if insulin response has changed in response to diet and lifestyle changes.

This is where the the homeostasis model assessment of insulin resistance (HOMA-IR) comes in – a tool easily used by clinicians and relying on standard blood tests.

Homeostasis model assessment of insulin resistance (HOMA1-IR) – Matthew’s Equations (1985)

The homeostasis model assessment was first developed in 1985 by David Matthews et al and is method used which quantifies insulin resistance and β-cell function of the pancreas from fasting blood glucose and either fasting insulin or C-peptide concentrations.

Pancreatic β-cells are responsible for insulin secretion in response to increasing glucose concentrations, so when there is decreased function of the pancreas’ β-cells, there will be a reduced response of β-cell to glucose-stimulated insulin secretion.

In addition, glucose concentrations are regulated by insulin-mediated glucose production in the liver, so insulin resistance is reflected by reduced suppression of hepatic glucose production, stemming from the effect of insulin.

The HOMA-IR model describes this glucose-insulin homeostasis using a simple equation, based on fasting blood glucose and fasting insulin. The equation uses the product of fasting plasma insulin (FPI) x fasting plasma glucose (FPI), divided by a constant of 22.5, providing an index of hepatic insulin resistance:

HOMA1-IR = FPI (mu/I) x FBG (mmol/L) / 22.5

The “Blood Code” book is based on these 1985 equations. The problem with the Matthew’s Equations is that they underestimate Insulin Sensitivity (%S) and overestimate % β-cell function.

Homeostasis model assessment of insulin resistance (HOMA2-IR)

Oxford University, Centre for Diabetes, Endocrinology and Metabolism in the UK, has designed a HOMA2-IR model (2013) that estimates β-cell function (%B) and insulin sensitivity (%S) for an individual from simultaneously measured fasting plasma glucose (FPG) and fasting plasma insulin (FPI) values. It also can be used with fasting specific insulin or C-peptide values, instead of fasting RIA insulin.

The HOMA2-IR calculator provides % β-cell function (% B ) and % Insulin Sensitivity (%S): https://www.dtu.ox.ac.uk/homacalculator/download.php.

It is important to note that HOMA-IR values vary by ethnic group, but looking at humans as one, a normal HOMA-IR value for a healthy person ranges from 0.5-1.4

  • Less than 1.0 means you are insulin-sensitive which is optimal.
  • Above 1.9 indicates early insulin resistance.
  • Above 2.9 indicates significant insulin resistance.

Use of Tools

While these tools are primarily used by clinicians, knowing about them is useful in being proactive in managing one’s own health.  For example, if you have already started making the dietary and lifestyle changes to lower insulin resistance, having your fasting insulin measured along with your fasting blood glucose, will enable your doctor or myself to calculate your progress, as well as recommend adjustments in your plan.

Have questions?

Why not send me a note using the “Contact Us” form at the top of this web page.

To our good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

References

Gutch, M, Kumar, S, Razi, SM, et al,  Assessment of Insulin Sensitivity / Resistance, Indian J Endocrinol Metab. 2015 Jan-Feb; 19(1): 160–164.

HOMA Calculator©, University of Oxford, Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism: https://www.dtu.ox.ac.uk/homacalculator/download.php


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Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

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Part 1: What is Insulin Resistance?

The hormone insulin plays a number of roles, one of which is to help move the glucose that is produced from the digestion of food – from the blood and into the cells for energy. Insulin resistance is where the body isn’t responding to insulin’s signals to take up glucose, so blood glucose remains high, despite normal or high levels of insulin.

Type 2 Diabetes (T2D) is essentially a state of very high insulin resistance.

Insulin normally goes up when we eat foods that contain carbohydrate (breads, pasta, rice, fruit, milk products, etc.) and acts on the liver to help store the incoming food energy – first as glycogen and when liver and muscle glycogen stores are “full”, it acts to store the excess energy as fat (de novo lipogenesis).

When we haven’t eaten for a while or are sleeping, the hormone glucagon acts to break down the glycogen in our muscles and liver (glycogenolysis) in order to supply our brain and cells with glucose. Insulin acts to inhibit glucagon’s action, which signals the body to stop making new glucose from its glycogen stores. When our glycogen stores run out (such as when we are fasting), the body turns to non-carbohydrate sources such as fat to make the glucose it needs for essential functions (gluconeogenesis).

When we are insulin resistant, insulin continues to act on the liver to signal it to store energy. When glycogen stores are “full”, it stores the excess energy as fat. When fat stores are “full”, the body starts storing the excess fat that the liver keeps making, inside the liver itself.  There shouldn’t be fat in the liver, but when we are insulin resistant, such as in Type 2 Diabetes excess fat gets stored in the liver in a condition known as “fatty liver disease”.

In insulin resistance, the liver becomes more sensitive to insulin’s signal to make fat (and as a result keeps making more and more fat) yet at the same time, the liver becomes less sensitive to insulin’s inhibition of glucagon – resulting in more and more glucose being produced and released in the blood.

High levels of glucose remain in the blood despite adequate insulin, and it is this high level of blood glucose that is the hallmark symptom of Type 2 Diabetes. For the same quantity of insulin released, the body moves less and less glucose into the cell. 

What does the body do to compensate? It makes more insulin!

KEY POINT: Insulin resistance results in the increased production of insulin. Increasing blood sugar CAN a symptom, caused by the insulin resistance, but blood glucose can be normal and one can still be insulin resistant (see Featured Article on Insulin Resistance).

When we are insulin resistant and keep eating a carb-based diet, the body requires more and more insulin in order to move the same amount of glucose into the cell.

The main issue then becomes too much insulin (hyperinsulinemia).

Defining the Problem Defines the Treatment

In Type 2 Diabetes (which is in essence, very high insulin resistance), the symptom is high levels of glucose in the blood. That is not the cause. It is the symptom.

High levels of glucose in the blood resulting from uncontrolled Type 2 Diabetes, results in proteins in the body becoming “glycosylated”. Glucose, is a highly reactive molecule and easily accepts (or “shares”) electrons from other molecules – especially from the amino acid Lysine, which is found in virtually every protein in the body. When Lysine and glucose share an electron, it creates an irreversible chemical bond between the glucose molecule and the protein – and that protein is said to have become glycosylated. It is this glycosylation that lies behind the complications found in Diabetes.

To reduce the glucose in the blood and the glycosylation of the body’s proteins, current treatment for Type 2 Diabetes involves medications that move glucose from the blood into the cells. This doesn’t really remove the excess glucose from the body, it simply moves it to a different location in the body. While these medications can be very helpful in the short term (until people begin to address the underlying dietary causes), over time these medications become less and less effective at removing glucose from the blood. In a sense, we become “medication resistant”, so additional medications are added.  Once the various combinations of medications loose their effectiveness, people with Type 2 Diabetes are prescribed insulin as a treatment – because insulin moves excess glucose into the cells. But the cells are already overflowing with too much glucose!

Insulin is added as a treatment when the body is already producing too much insulin.  The problem is the cells aren’t responding to the signal from insulin. The body doesn’t need more insulin – it needs the cells that are sensitive to respond to insulin’s signal.

Diabetes as a “chronic, progressive disease”

Type 2 Diabetes is described as a “chronic, progressive disease” because with current medication treatment, people eventually get worse. When they no longer respond to the initial medications  prescribed that help move excess glucose from the blood into the cells, they are prescribed insulin which they take by injection – in order to force more glucose into already over-full cells.  While people’s blood glucose gets better (i.e. the symptom improves), they gain weight as a result of the insulin injections and develop complications such as heart disease, stroke, kidney disease, blindness etc..

In the end, they don’t get better, but worse, fulfilling the belief that T2D is a chronic, progressive disease.

Redefining the Problem, Redefines the Solution

Rather than looking at the symptom (high blood glucose) as something that needs to be “fixed” with medications and later with insulin (when the medications are no longer effective), when we define insulin resistance and Type 2 Diabetes as a problem of excess insulin, we approach addressing the problem differently.

By changing what we eat, we can lower the amount of glucose in the body, which in turn causes the body to produce less insulin.  With less insulin being produced, the cells begin to respond to normal amounts of insulin  – reversing insulin resistance and yes, reversing the symptoms of Type 2 Diabetes.

Eating a low carb high fat diet and extending the amount of time between meals (intermittent fasting) lowers the production of insulin, resulting in the cells become more sensitive to its signal. Rather than addressing the symptom (which is high blood glucose) we are addressing the problem of too much insulin.

Have questions? Would like to know how I could help you?

Why not send me a note using the “Contact Us” form on the tab above.

To our good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

In Part 2, I will explain how insulin resistance is measured and how we can track insulin sensitivity returning, as we continue to eat a low carb diet and increase the time between meals.

Copyright ©2017 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read or heard in our content. 

 

 

 

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Insulin and Leptin – very different effects in lean versus overweight people

The hormone insulin (involved in storing fat) and leptin (involved in burning fat) work very differently in lean people than in overweight people. This is why excess fat such as is found in “bullet proof coffee” or “fat bombs” results in overweight (or obese) people that follow a Low Carb High Fat diet gaining weight—whereas lean people will simply burn it off. This article explains the role of these hormones and how they impact lean people and overweight people very differently.

When we eat, the hormone insulin is released which signals our body to do two things; (1) it tells our cells to uptake energy (in the form of glucose) and (2) to store excess energy as fat. Insulin is the major driver of weight gain. If we are lean, when we eat more than usual and increase our body fat stores, the body responds by increasing secretion of a hormone called leptin.  Leptin acts as a negative feedback loop on the hypothalamus area of our brain, reducing our hunger, causing us to eat less and preventing us from gaining too much fat.

The problem occurs when we become insulin resistant.

Insulin Resistance

When we eat a diet that is high in carbs and we eat every few hours (3 meals plus snacks), insulin is released each time we eat (in order to cause our cells to take in energy and store the excess as fat). If we continue to eat this way, over time our body is inundated with insulin, so it sends signals to down-regulate the insulin receptors, making our cells less sensitive to insulin signals. This is called insulin resistance. When we are insulin resistant, our body releases more and more insulin to deal with the same amount of glucose in the blood.

Leptin Resistance

Consistently having high levels of insulin, will also keep stimulating the release of leptin, which normally results in us becoming less hungry and eating less. However, when we are insulin resistant, we keep producing more and more insulin, which results in us producing more and more leptin. Over time, this consistently high leptin level will result in the same type of down-regulation of hormonal receptors that occurred with insulin, resulting in leptin resistance.

Leptin resistance interferes with the negative feed back loop on our hypothalamus which normally reduces our hunger, causing us to eat less. When we are leptin resistance, even when we’ve eaten a great deal of food, we don’t feel satiated — even when our abdomens are straining from feeling full. As a result, we just keep eating, as if there is no “off” switch.

It is this leptin resistance that results in obesity.

Obese people aren’t obese because they lack will-power, but because their body is responding to signals from very powerful hormones produced in response to the types of foods they eat.

Difference between a High Carb Diet and a High Fat Diet

When people consume diets high in carbs it stimulates insulin to be released. In response to all the insulin, energy that is not immediately needed for activity is stored as glycogen in the liver and muscle cells, and the remainder is shipped off to our adipose cells (fat cells), to be stored as fat. When eating a high carb diet, getting excess calories into fat cells is easy, getting the fat out of fat cells, not so much.

When people eat a diet high in fat and low in carbs, the fat is absorbed in the intestines as chylomicrons and is shuttled through the lymphatic system to the thoracic duct, going directly into the blood circulation. From there, the fat is either burned for energy or goes into our fat cells, to be stored. It is important to note that the fat does NOT go to the portal circulation of the liver and as a result, fat needs no help from insulin to be absorbed.

That’s good, but if excess fat gets stored in fat cells, doesn’t eating fat make one fat?

Not for lean people, because lean people are leptin sensitive and obese people are leptin resistant. When overweight or obese people eat excess fat, it is a different matter.

Lean People versus Obese People

If a lean person eats a diet high in fat and low in carbs, the excess fat will be stored in fat cells, but insulin does not go up. So a lean person does not become insulin resistant, as described above.  As their fat mass goes up, leptin also goes up. Since the lean person is sensitive to leptin, the negative feedback loop acts on the brain causing them to stop eating, allowing their body weight to go back down. Even if a lean person deliberately eats more and more fat when they aren’t hungry, what happens is their body’s metabolism goes up, and they burn off the extra calories.

If an overweight or obese person eats a diet high in fat and low in carbs with moderate amounts of protein, insulin levels don’t go up — which is good of course, however from years of eating high carb low fat diets and from eating a carb rich foods every few hours, overweight and obese people are insulin resistant. This means that their blood glucose levels remain high for long periods after they’ve eaten and as importantly, it also means that they are also leptin resistant. In this case, if they eat too much fat – such as drinking “bullet-proof coffee” or having “fat bombs”, they will respond (as the lean person does) by making more leptin, but the problem is, they are not sensitive to leptin! Their brain doesn’t respond to the signals from leptin, so when an obese or overweight person eats excess fat, beyond that which is naturally found in a low carb high fat foods, their appetite doesn’t drop – nor does their metabolism go up to burn off the excess fat being stored in fat cells. They simply get fatter.

Weight Loss

For those that are overweight or obese and insulin resistant, it is important to keep in mind that with insulin resistance comes leptin resistance. Leptin resistance by definition means that the signals to stop eating don’t work.  The “off switch” is defective.  As well, the body doesn’t respond to signals from leptin to up-regulate metabolism, so when an overweight or obese person on a low carb diet eats too much fat, they gain weight.

Since increasing carbs is not an option and increasing protein results in glucose being synthesized from the excess (gluconeogenesis), the way to lower insulin resistance (and thus leptin resistance) is by extending the amount of time between meals.  This is known as intermittent fasting – a topic that will be covered in a future article.

Have questions?

Want to know how I can help you get started on a low carb high healthy fat diet?  Please drop me a note using the “Contact Us” form, located on the tab above.

To our good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

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Copyright ©2017 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


References

Ebbeling CB, Swain JF, Feldman HA, et al. Effects of Dietary Composition During Weight Loss Maintenance: A Controlled Feeding Study. JAMA : The journal of the American Medical Association. 2012;307(24):2627-2634. doi:10.1001/jama.2012.6607.

Feinman RD, Fine EJ (2003) Thermodynamics and metabolic advantage of weight loss diets. Metabolic Syndrome and Related Disorders, 1:209-219.

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Keto Water – replacing electrolytes

Many people who are accustomed to eating a carb-based diet, restrict their salt intake to avoid blood pressure, but when eating low carb high fat, there is the need to add salt to replace sodium right from the beginning. That is how “keto-water” came to be.

When eating low carb and when intermittent fasting (extending the amount of time between meals) insulin levels fall, and with it so does the kidney’s retention of sodium (salt). The kidneys excrete sodium in a process called naturesis so replacing the missing sodium is important. Sodium and potassium (as well as calcium and magnesium) are used in pairs in a number of systems in the body, so when the kidneys ‘dump’ a lot of sodium, potassium is soon excreted too, in order to balance the two electrolytes. If someone on a low carb diet doesn’t supplement sodium soon enough, their potassium levels could fall too low as a result, which may cause them to have excruciating headaches and/or irregular heart beat (heart palpitations).

It is fairly difficult to meet the Dietary Reference Intake for potassium on a conventional  carb-based diet, but on a low-carb diet – even with a very high non-starchy vegetable intake, it is still challenging as many of the good sources of potassium, such as potato and yams are not part of a low carb high fat diet. Mushrooms and avocado are some of the best sources, so include those foods often.

To be sure to get sufficient sodium and potassium, I make what I call “keto-water”.

NOTE: People with kidney disease (e.g. CKD) must avoid any salt substitutes or half-salts with potassium. Those taking blood pressure medication such as Ramipril have increased potassium retention and should also not use half-salts containing potassium.

“KETO-WATER”

Keto-water is 1 liter of club soda / seltzer to which 1/8 tsp of “half salt” has been added.

“Half salt” is a half-sodium / half-potassium salt that is sold under a number of brand names, including “Nu Salt” and “no Salt”.

I add a tiny twist of lime or lemon to round out the taste and also to add a source of Vitamin C and voila, “keto-water“!

Keto-water salts

Unless it is particularly hot out, or one’s needs are increased because they are exercising or have a fever, two liters a day of “keto-water” is probably sufficient for most people.

Keep in mind that drinking keto-water will result in your body retaining more water along with the sodium, so it may appear as if your ‘weight went up’, but it is only the natural water retention that occurs (and is supposed to occur) when your body has sufficient electrolytes. Remember, weight form most people can fluctuate by as much as 4 – 4 1/2 pounds per day solely from the natural fluctuation in body water, so don’t weigh yourself too much.  I recommend a maximum of once a week, on the same day and at the same time.  When you are replacing the body’s necessary electrolytes (such as sodium and potassium), it is better to judge fat loss by loss of inches around various parts of your body (mid-arm, mid-thigh, neck, abdomen) than by the scale. Even easier, go by how your clothes feel!

Please don’t restrict sodium when eating low-carb for the sake of a number on the scale!  Your body needs the sodium and potassium to function properly.

If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

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Copyright ©2017 The Low Carb High Fat Dietitian (a divisions of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read or heard in our content. 

 

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Tracking Carbs Instead of Counting Calories

I have found that people wanting to lose weight simply don’t want to weigh or measure food or count calories – and who can blame them! I design Meal Plans for my clients so they don’t need to. As I will explain in this article, with a Standard Meal Plan (based on a traditional macronutrient distribution), carbohydrate, protein and fat are all laid out, based on the food exchanges. With a Low Carb High Healthy Fat Meal Plan or a Hybrid Meal Plan, carbohydrate percent, protein- and fat percent are also laid out, but for those seeking to lower insulin resistance or lose weight or both, tracking carb intake is important.  In this article, I’ll explain tracking carbs.

Firstly, what is a Meal Plan?

A Meal Plan isn’t a “menu” that tells you what foods you have to eat, but indicates how many servings of each category of food you should aim to eat at each meal. I explain more about what a food category is, below.

The first step in designing a person’s Meal Plan after I’ve done their assessment, is to determine their overall caloric needs based on age, gender, activity level, desired weight loss (or gain), as well as any special considerations such as growth, weight loss, pregnancy or lactation, etc.

More about calories in the next article, but suffice to say here, calories are generally not the focus in Low Carb High Healthy Fat eating, carbs are.

The next step is to set the macronutrient distribution (% of calories from carbohydrate, protein and fat) of the Meal Plan according to what would best suit the person’s clinical needs, goals and lifestyle. This is something I discuss with people during the assessment, and which is ultimately up to them.  The Standard macronutrient distribution is ~45-65% carbohydrate, ~15-20% protein and ~30% fat. Generally speaking, unless there is a compelling clinical reason for using a Standard Meal Plan, I encourage people to consider the benefits of a low carb high healthy fat eating.

The Low Carb High Healthy Fat macronutrient distribution is ~5-10% carbohydrate, ~20% protein and ~65-70% healthy fat, with the Hybrid macronutrient distribution falling somewhere in between.

In the final step, I design a person’s Meal Plan based on the foods that they’ve told me they like, avoiding those they don’t, and factoring in the time of day they either need to (for scheduling reasons) or prefer to eat. Then we meet for me to go over their Meal Plan with them, and for me to teach them how to easily and accurately estimate their portion sizes, using visual measures. More on visual measures, below.

The only thing left for them to decide is what they want to eat!

Food Categories – Standard Meal Plan

In a Standard Meal Plan or Hybrid, categories include Starchy Vegetables and Grains, Fruit, Non-Starchy Vegetables, Meat, Poultry, Meat and Egg or Cheese, and Legumes (pulses). These categories are based on how many grams of carbs are contained in the foods in make up that category.

Take, for example, the Starchy Vegetable and Grain Category.  This group includes all the standard “carbs” such as bread, pasta, rice and cereals as well as “starchy vegetables” such as peas, corn, potatoes, sweet potatoes / yams and winter squash (such as acorn or butternut squash). All foods in this category have 15 gm of carbs per serving (where a serving is 1/2 cup or the equivalent of 1 slice of bread).

So, 1 slice of bread has 15 gms of carb, 1/2 cup of peas has 15 gms of carb, 1/2 cup of rice has 15 gms of carb, 1/2 cup of oatmeal has 15 gms of carb, and 1/2 a hamburger bun has 15 gms of carb.

If a person’s Meal Plan indicates that they can have 2 servings from the Starchy Vegetable and Grain category, that could be 2 pieces of toast, or 1 cup of oatmeal, or 1 cup rice, etc. Their Meal Plan doesn’t tell them what food they have to eat, just how much from each category.

Here is an example of what a Standard Meal Plan looks like;

 

 

As you can see, all the calculations have been done.

In this example, this Meal Plan was for an 85 year old man who wanted to gain weight and was based on 45% of his calories coming from carbs, 21% from fat and 34% from fat.

Estimating Portion Sizes

When I’ve taught someone to accurately estimate their serving sizes using visual measures, the amount of macronutrients (carbs, protein, fat and calories) they will take in following their Meal Plan will be what was planned.

What are Visual Measures?

Visual measures are easy and accurate means to estimate serving sizes. For in-person clients, this might be based on the size of their hand or fingers, such as (depending on the size of a person’s hand) a 1/2 a cup (dry measure) may be the amount of something round (like frozen peas) that could be contained in their scooped hand, without rolling out. An ounce (by weight) might be the size of two specific fingers on their hand, or a Tbsp may be the amount of the last digit on their thumb. For Distance Consultation clients, the standard used in teaching visual measures are standard size items, such as the size of a golf ball or four dice stacked up.

Tracking Carbohydrates

Where tracking carbohydrates comes into play is with Low Carb High Healthy Fat Meal Plan or a Hybrid Meal Plan – especially when lowering insulin levels or losing weight is desired. Keeping track of carbohydrates on these kind of Meal Plans is nothing like needing to count calories! It is very easy.

On a Low Carb High Healthy Fat Meal Plans, the macronutrient distribution for carbs is set quite tightly. For men, total carbs would be somewhere between 80-100 grams and for women, it may be set as low as 35 gms carb or as high as 50 gms. It depends on their needs. Naturally, Hybrid Meal Plans will have higher total daily carbs.

Since there are no Starchy Vegetables and Grains and Milk on these Meal Plans (cheese is used, just not milk due to the carb content), the Food Categories on a Low Carb Meal Plan or Hybrid are different than on a Standard (or traditional) Meal Plan).

Food Categories in a Low Carb Meal Plan include Non-Starchy Vegetables, which exclude “Starchy Vegetables” such as peas, corn, potatoes, sweet potatoes / yams and winter squash – with some intake guidelines around root vegetables such as carrots, beets and parsnips. The Fruit category here is specified more narrowly than in a Standard Meal Plan – generally focused on berries and low sugar citrus such as lime and lemon, as well as tomatoes and cucumbers (yes, both are technically ‘fruit’).

Meat, Poultry, Meat and Egg or Cheese is pretty much the same as with a Standard Meal Plan, with an ounce of any of these protein foods being 1 serving and individuals being able to have several servings at each meal (based on their caloric needs, factoring in any weight loss). The fat contained in the Meat, Poultry, Meat and Egg or Cheese is already calculated when the Meal Plan is made, so “Fat” here means added fat. The Fat category includes everything from olive oil, avocado (both the fruit and the oil), coconut oil, butter, olives and nuts and seeds.

Foods in the Meat, Poultry, Meat and Egg or Cheese category have little or no carbs in them and Non-Starchy Vegetables are generally around 5 gm of carb per cup and berries, which are in the Fruit category are roughly 15 gm of carb for 1/2 a cup. A few berries on a salad isn’t usually a problem, but more than that can easily put us over our maximum amount of carbs for the day, which I call the “carb ceiling”.

Where it becomes particularly important to track carbohydrates when one is seeking weight loss is with foods such as nuts and seeds.  It is very easy to eat a handful of nuts and end up exceeding one’s daily maximum number of carbs.

[an article written a month earlier will provide detailed information regarding the carbohydrate content of nuts: https://www.lchf-rd.com/2017/05/23/oh-nuts/]

Carb Creep

“Carb-creep” is when we eat more carbs than we think we are, which results in weight loss slowing, or even stopping. When one reaches a plateau  where they haven’t lost any weight for longer than a week or two, then tracking carbs to see if there is carb creep is advised.

A man’s carb limit may be set to 80-100 gms per day and a woman’s may be as low as 35 gms or as high as 50 gms.  That is not a lot and it is easy to inadvertently exceed this amount of carbs in the course of a day. A few splashes of milk in several cups of coffee, a handful of peanuts walking by the bowl near the photocopier and an ounce or two of 72% dark chocolate (for heart health, of course!) can quickly put us over our carb ceiling. This is where it’s important to evaluate food choices that may be putting your over your carb ceiling.

Want to know more about having a Meal Plan designed for you?

Please send me a note using the “Contact Us” form above and I will reply to you, usually by the next business day.

To our good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

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Copyright ©2017 The Low Carb High Fat Dietitian (a division of BetterByDesign Nutrition Ltd).  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


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One in Two People Will Get Cancer – new report finds

A new report released by the Canadian Cancer Society predicts that almost one in two Canadians will be diagnosed with cancer in their lifetime.

“One half” is a very sobering number!

Currently, cancer is the leading cause of death in Canada, accounting for almost 1/3 of all  of all deaths (30%).

Heart disease is the second leading cause of death, accounting for 1/5 of all deaths (20%).

In an interview with Peter Goffin of the Toronto Star, Dr. Robert Nuttall, Assistant Director of Health Policy at the Canadian Cancer Society attributed this alarming new statistic that 1/2 will get cancer in their lifetime to the “aging population” – not “lifestyle factors”. 

Nutall said;

“The important thing to remember here is that the biggest driver behind this is the aging population. “Canadians continue to live longer, and cancer is primarily a disease that affects older Canadians.”

Japan has the oldest population in the world, with ~1/3 of people aged over 60.

What do their statistics show?

According to the Institute for Health Metrics and Evaluation, Japan’s leading causes of death (2015) were:

  1. cerebrovascular disease (stroke)
  2. cardiovascular disease (heart disease)
  3. lower respiratory infection
  4. Alzheimer’s disease

Lung cancer was 5th, followed by stomach cancer (6th) and colorectal cancer (7th). In Japan, a country with the oldest population in the world, cancer of any kind wasn’t even in the top four!

Are half of us really going to get cancer because of the “aging population” or is it because of “lifestyle factors”?

Looking at the top 4 Causes of Cancer in Canada:

Ten Most Common Cancers in Canada – projected for 2017
  1. Lung cancer is the number one form of cancer and the Canadian Cancer Society indicates that more than 85% of lung cancer cases in Canada are related to smoking tobacco.

  2. Colorectal cancer is the second leading cause of cancer and the Canadian Cancer Society indicates that risk factors for colorectal cancer include (a) diet , (b) being overweight, (c) physical inactivity and (d) smoking.

  3. Breast cancer (in both men and women) is the third leading cause of cancer. Apart for personal and family history of breast cancer and other genetic factors, the Canadian Cancer Society list the following known risk factors: (a) exposure to ionizing radiation, (b) use of oral contraceptives (c) alcohol and (d) being obese.

  4. Prostrate cancer which only affects men, is the fourth leading cause of cancer and the only known risk according to the Canadian Cancer Society is family history.

Major Risk Factors for the top 4 Causes of Cancer

Here are the major risk factors for the top four leading causes of cancer in Canada;

  1. smoking
  2. diet
  3. being overweight
  4. physical inactivity
  5. exposure to ionizing radiation (x-rays)
  6. use of oral contraceptives
  7. alcohol

Except for use of x-rays, all of these are lifestyle factors!

Diet, being overweight and being inactive are three things that can be changed easily and sustainably!

A low carb approach can be particularly helpful, as it can not only address being overweight, but new studies have found that a number of cancer cells feed exclusively on glucose.  It is thought that a ketogenic lifestyle may play a role in reducing the glucose available for some types of cancer.

We being told that the biggest driver behind the projection that half of us will get cancer in our lifetime is the aging population‘ – when it would seem that the underlying risk factors of these cancers are lifestyle factors.

In fact, the Canadian Cancer Society says themselves that half of the cases are preventable;

“We already know a lot about how to prevent cancer. If we, as a society, put everything we know into practice through healthy lifestyle choices and policies that protect the public, we could prevent about half of all cancers.”

We will all age and this is not preventable, but by addressing lifestyle factors including smoking, diet, overweight and physical inactivity and others, we should be able to prevent almost 1/2 of all cancers.

Have questions on how I can teach you how to eat healthier and work with you to help you tackle being overweight and inactive, then please send me a note using the “Contact Us” form on this web page.

To your good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2017 The Low Carb High Fat Dietitian (a division of BetterByDesign Nutrition Ltd).  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


References

Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-type/lung/risks/?region=on#ixzz4kZ5AnNz6

Canadian Cancer Society, http://www.cancer.ca/en/about-us/for-media/media-releases/ontario/2011/not-enough-canadians-being-screened-for-colorectal-cancer-leading-to-many-unnecessary-deaths/?region=on#ixzz4kZ5vSGSS

Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-type/breast/risks/?region=on#ixzz4kZ8RvXbm

Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-type/prostate/risks/?region=on#ixzz4kZ9J6o64

Canadian Cancer Society, http://www.cancer.ca/en/cancer-information/cancer-101/cancer-research/prevention/?region=on#ixzz4kZ9jQJwt

Institute for Health Metrics and Evaluation, http://www.healthdata.org/japan

The Toronto Star, Peter Goffin (Staff Reporter), Tue June 20 2017, https://www.thestar.com/news/gta/2017/06/20/half-of-all-canadians-will-get-cancer-in-their-lifetime.html

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New Obesity Study Sheds Light on Dietary Recommendations

As mentioned in the previous article, a new study published Monday, June 12, 2017 in the New England Journal of Medicine analyzed data from 68.5 million adults and children in 195 countries and found that 1/3 of people worldwide are overweight or obese and are at increased risk of chronic disease and death, as a result.

Data from one country, China, stood out among all of them due to record high rates of childhood and adult obesity;

  • In 2015, China had the highest incidence of obese children in the world (~10%) along with India.
  • In 2015, China along with the US had the highest incidence of obese adults (>35%).

I wanted to have a look at the Dietary Guidelines for Chinese Residents (Chinese: 中国居民膳食指南) in the years prior to 2015, to determine how they may have contributed to these high rates of overweight and obesity.

The Food Guide Pagoda

The Chinese Dietary Guidelines, known as the ‘Food Guide Pagoda’ was first published in 1989 and revised in 1997. The 2007 revision was developed in conjunction with a committee from the  Chinese Nutrition Society, in association with the Ministry of Health.  A new revision came out in 2016.

The 2007 ‘Food Guide Pagoda’ (the one that was in effect at the time the 2015 overweight and obesity statistics came out) was divided into five levels of recommended consumption corresponding to the five Chinese food groups.

  1. Cereals – in the form of rice, corn, bread, noodles, crackers and tubers make up the base of the Pagoda.
  2. Vegetables and Fruits – form the second level of the Pagoda
    According to the Chinese Dietary Recommendations, the majority of foods in each meal should be made up of cereals, including rice, corn, bread, noodles, crackers and tubers (such as potatoes), followed by Vegetables and Fruit.
  3. Meat, Poultry, Fish & Seafood and Eggs form the third level, and it is recommended that should be ‘eaten regularly’, but ‘in small quantities’.
  4. Milk & Dairy and Bean & Bean Products – form the fourth level.
  5. Fat, Oil and Salt – form the roof of the Pagoda and are recommended to be eaten in moderation.

Specific Dietary Recommendations (2007-2015)

The main recommendations of the 2007 Chinese Dietary Guidelines were as follows:

  • Eat a variety of foods, mainly cereals, including appropriate amounts of whole grains.
  • Consume plenty of vegetables, fruits and tubers (e.g. potato, taro, yam etc.)
  • Consume milk, beans, or dairy or soybean products every day
  • Consume appropriate amounts of fish, poultry, eggs and lean meat.
  • Reduce the amount of cooking oil
  • Divide the daily food intake among the three meals and choose suitable snacks.

The Results (2005-2015)

1. Leading cause of death

In 2015, heart disease overtook Chronic Obstructive Pulmonary Disease (COPD) as the second leading cause of death, followed by stroke.

In 1990, the leading cause of death in China was Chronic Obstructive Pulmonary Disease (COPD) largely contributed to by smoking, followed by heart disease and diarrhea.


2. Leading cause of premature death

In 2015 as in 2005, stroke was the leading cause of death, followed by heart disease.

 


3. What caused the most death and disability combined?

In 2015, stroke was leading cause of death in China, followed by heart disease.

 


Magnitude of the Problem – China compared to the US and Canada

In 2015, for every 100,000 people in China, 2,237 people died from heart disease and 1,672 people died from stroke.

In the US, for every 100,000 people, 457 people died from heart disease and 1,617 died from stroke.

In Canada, for every 100,000 people, 327 people died from heart disease and 1,106 died from stroke.

Rates of stroke in the China and US were quite similar. Both China and the US had the highest number of obese adults (>35%) in the world.

China’s “solution”?

China concluded that “dietary risks drive the most death and disability” – especially stroke and heart disease which were the two leading causes of all forms of death, of premature death and of disability in 2015.

In response to these high rates of stroke and heart disease among Chinese, the Chinese government, with the assistance of the Chinese Nutrition Society produced a revised version of the Chinese Food Pagoda in 2016.

New Dietary Recommendations (2016)

The Chinese have stated that “there have been no significant changes in dietary recommendations” (Wang et al, 2016) when compared with the previous version of the 2007 Food Pagoda and are emphasizing the following recommendations:

Eat a variety of foods, with cereals as the staple – The daily amount of cereals and potatoes consumed for body energy production should be 250–400 g, including 50–150 g of whole grains and mixed beans, and 50–100 g of potatoes. The major characteristic of a balance diet pattern is to eat a variety of foods with cereals as the staple.

Balance eating and exercise to maintain a healthy body weight – this is based on the same “calorie in / calorie out” model that the US and Canadian recommendations have been based on. “Avoiding ingesting excessive food and physical inactivity is the best way to maintain energy balance”.

Consume plenty of vegetables, milk, and soybeans – The daily vegetable intake should be in the range of 300–500 g. Dark vegetables, including spinach, tomato, purple cabbage, pak choy, broccoli, and eggplant, should account for half this amount and should appear in every meal. Fruits should be consumed every day. The daily intake of fresh fruits, excluding fruit juice, should be between 200 and 350 g. A variety of dairy products, equivalent to 300 g of liquid milk, should be consumed per day. Bean products and nuts should be frequently eaten in an appropriate amount for energy and essential oils.

Consume an appropriate amount of fish, poultry, eggs, and lean meat – The consumption of fish, poultry, eggs, and meat should be in moderation. The appropriate weekly intake is set at 280–525 g of fish, 280–525 g of poultry, and 280–350 g of eggs with an accumulated daily intake of 120–200 g on average. Fish and poultry should be chosen preferentially. The yolk should not be discarded when consuming eggs, and less fat and fewer smoked and cured meat products should be eaten.

Final Thoughts…

China now has some of the highest rates of childhood obesity in the world (~10%) and is tied with the US for the highest rate of adult obesity (>35%) yet to address the issue of incredibly high rates of stroke and high rates of heart disease, the 2016 Chinese Dietary Recommendations define a balance diet pattern as a daily adult intake of;

1/2 lb – 1 lb (250-400 gm ) of cereals, grains and potatoes

1/3- 3/4 lb (200 – 350 gm) of fresh fruit

1 1/2 cups of milk

and

1/4 lb – 1/3 lb of fish, poultry or eggs (with meat “in moderation”)

These “new” recommendations seem to be based on the same “calorie in / calorie out” model familiar to us in the West and that fail to take into account how the body compensates on a carbohydrate-based calorie restricted diet diet (see previous blogs).

The Chinese are being told that “the best way to maintain energy balance” (Wang et al, 2016) is to;

  1. exercise more (150 minutes/week plus 6000 steps/day)
  2. eat less fat and animal protein
    and
  3. consume most of their calories as rice, corn, bread, noodles, crackers and potatoes 

Over the last four decades,  Americans and Canadians have reduced their fat consumption from ~40% in the 1970’s to ~30%, increased the amount of carbohydrate as whole grains, fruits and vegetables, are consuming low fat milk, eating more fish and drinking less pop and presently, 2/3 of adults considered overweight or obese.

Should we expect different results in China?

If you are looking to achieve a healthy body weight, lower blood sugar, blood pressure and triglycerides, I can help.

I take a low carb high health fat approach and can teach you how to eat well, without weighing or measuring food, or counting “points”.

Want to know more? Send me a note using the “Contact Us” form, on the tab above.

To our health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2017 The Low Carb High Fat Dietitian (a division of BetterByDesign Nutrition Ltd).  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


You can follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/


References

Global Burden of Disease (GBD) 2015 Obesity Collaborators, Health Effects of Overweight and Obesity in 195 Countries over 25 Years, N Engl J Med, DOI: 10.1056/NEJMoa1614362

Global Health Data Exchange (GHDx), http://ghdx.healthdata.org/geography/china

Wang S, Lay S, Yu H, Shen S. Dietary Guidelines for Chinese Residents (2016): comments and comparisons. Journal of Zhejiang University Science B. 2016;17(9):649-656. doi:10.1631/jzus.B1600341.

 

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Obesity Pandemic – new study

In the last few years, we’ve heard the term “obesity epidemic“, but a new study published this past Monday, June 12, 2017 in the New England Journal of Medicine seems to indicate that it is now an “obesity pandemic”.

Researchers analyzed data from 68.5 million adults and children in 195 countries to assess (1) the prevalence of overweight and obesity in 2015 and (2) the trends in the prevalence of overweight and obesity between 1980 and 2015.

The “short story” is that a 1/3 of people worldwide are now overweight or obeseput another way, two billion people globally are overweight or obese and are at increased risk of morbidity (chronic diseases) and morbidity (death), as a result.

The Significance

Epidemiological studies (studies of different populations from around the world) have identified high BMI as a risk factor for cardiovascular disease, type 2 Diabetes, hypertension, chronic kidney disease and many types of cancer.

Furthermore, overweight children are at higher risk for the early onset of diseases such as type 2 Diabetes, hypertension and chronic kidney disease.

Body Mass Index (BMI) is the weight in kilograms divided by the square of the height in meters Obesity is defined as having a Body Mass Index (BMI) > 30 kg/(m)2 Overweight is defined as having a BMI between 25 and 29.9 kg/(m)2

Obesity Findings

Data showed that in 2015, there were 603.7 million obese adults worldwide and 107.7 million obese children.

The prevalence of obesity has more than doubled in 70 countries since 1980, and there has been a tripling of obesity in youth and young adults in developing, middle class countries such as China, Brazil, and Indonesia.

Worldwide, the prevalence of obesity is now 5% in children and 12% in adults — findings that mirror global trends in type 2 Diabetes.

Most alarming was that in 2015;

  • high BMI accounted for four million deaths globally
  • almost 40% of deaths resulting from high BMI occurred in people who were overweight, but not obese
  • more than 2/3 of deaths related to high BMI were due to cardiovascular disease

Varying Risk

It is important to note that risk of outcomes related to obesity has not been found to be uniform across populations. For example, it has been reported that at any given level of BMI, Asians have been shown to have a higher absolute risk of Diabetes and hypertension, whereas African Americans have a lower risk of cardiovascular disease than other groups.

Addressing the Problem

To address the problem of overweight and obesity both here and around the world, requires correctly identifying its cause and for the last 40 years, excess dietary fat — especially saturated fat has been blamed as the villain and ostensibly responsible for the “obesity epidemic” and resulting “diabetes epidemic”.

But is it?

When one compares the Dietary Recommendations in both Canada and the United States since 1977 to rates of overweight and obesity in both of these countries, it seems apparent that it has been the promotion of diets high in carbohydrate that lies at the root.

In the next article, I’ll take a look at the Dietary Recommendations of the country with the highest rate of childhood obesity and adult obesity in 2015, as well as some of the highest rates of stroke and heart disease per capita, in the world.

How I can help

If you have eaten a ‘low fat diet’ and counted calories (or points) until you are blue in the face and are tired of doing the same thing over and over again, expecting a different outcome, why not drop me a note using the “Contact Us” form, above. I’d be glad to explain how I can help you achieve a healthy body weight, while normalizing your blood sugar, blood pressure and cholesterol levels.

To your health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2017 The Low Carb High Fat Dietitian ( a division of BetterByDesign Nutrition Ltd).  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


you can follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/


References

Global Burden of Disease (GBD) 2015 Obesity Collaborators, Health Effects of Overweight and Obesity in 195 Countries over 25 Years, N Engl J Med, DOI: 10.1056/NEJMoa1614362

Gregg EW, Shaw JE, Global Health Effects of Overweight and Obesity, N Engl J Med, doi: 10.1056/NEJMe1706095

Karter AJ, Schillinger D, Adams AS, et al. Elevated rates of diabetes in Pacific Islanders and Asian subgroups: the Diabetes Study of Northern California (DISTANCE). Diabetes Care 2013; 36:574-9

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Oh Nuts!

One of the challenges with trying to lose weight is reaching a plateau – where one’s weight stays the same for an extended period of time. When eating a low-carb or ketogenic diet, some foods such as nuts are a common pitfall. Despite being a rich source of heart healthy monounsaturated fats, some nuts contain high amounts of carbohydrate.


Carbs Per Serving of Nuts

Serving Size

A serving size* of nuts is generally considered one ounce (1 oz.) which is about a handful of an ‘average-sized hand’. The problem with using this kind of measurement is that not all nuts have the same mass per volume, nor does everybody have the same size hand!

Here are the number of nuts per ounce for common varieties:

  1. Cashew 16-18 nuts per ounce
  2. Pistachio 45-47 nuts per ounce
  3. Almond 22-24 nuts per ounce
  4. Pine Nuts ~3 Tbsp. (160 kernels) per ounce
  5. Hazelnut 10-12 nuts per ounce
  6. Walnut 8-10 halves per ounce
  7. Peanut 27-29 nuts per ounce
  8. Macadamia 10-12 nuts per ounce
  9. Pecan 16-18 halves per ounce
  10. Brazil Nuts 6-8 nuts per ounce

* When eating shelled nuts, many people eat a few palm fulls, so I’m going to indicate the carbs for a 1 oz and 3 oz serving.

Carbs are listed as “net-carbs” (i.e. once fiber (which is not digestible) has been subtracted from the total amount of carbohydrate).

Carbohydrates per Ounce

  1. Cashew
    Cashews aren’t actually “nuts” but are the fruit of a cashew apple, and contain 9 gms of carbs per 1 oz (~17 nuts) – that’s 27 gms of carbs for 3 oz (~ 3 average handfuls). To think of this in terms of “carb foods”, that’s about the same number of carbs as in 2 slices of bread!


2. Pistachio
Pistachios contain 6 gms of carbs per 1 oz serving ~ 46 nuts – that’s 18 gm of carbs in an average 3 handful serving (3 oz) – a little more than a slice of bread.


3. Almonds

Almonds contain approximately 3.5 gms of carbs per ounce ~23 nuts, which amounts to 10 gms of carbs for 3 oz (~3 average-sized handfuls).


4. Pine Nuts

Pine nuts (also called pignolias) contain 3 gms of carbs per oz. (which is about 3 Tbsp.)

 


5. Hazelnut

Hazelnuts (~11 nuts per ounce) contain ~2 1/2 gms of carbs for a 1 oz serving (~11 nuts) / 7 gms of carbs for 3 oz / 3 average handfuls.

 


6. Walnut

An ounce of walnuts (9 halves per ounce) contain the same amount of carbs as an ounce of hazelnuts (~2  1/2 gms of carbs for a 1 oz serving / 7 gms of carbs for 3 average handfuls or ~ 27 halves.


7. Peanut

An ounce of peanuts (~28 shelled peanuts per ounce) also contain the same amount of carbs as an ounce of hazelnuts or walnuts (~2  1/2 gms of carbs for a 1 oz serving.

 


Top three low carb high fat / keto-friendly nuts:

Macadamias, Pecans and Brazil nuts are the 3 most low-carb and keto-friendly nuts – having between 4 and 5 gms of carbs for a 3 oz serving! That’s far better than the 27 gm of carbs for 3 oz of cashews and 18 gm of carbs for 3 oz of pistachios!

8. Macadamia

Macadamias have slightly more than 1  1/2 gms of carbs for a 1 oz serving (~11 nuts) / 5 gms of carbs for a 3 oz serving.

 


9. Pecans

Pecans have 1.3 gms of carbs for an ounce of nuts (~17 halves) / 4 gms of carbs for a 3 oz serving .

 

 

 


10. Brazil nuts

 

Brazil Nuts also have only 4 gms of carbs for a 1 oz. serving (~ 7 nuts)

 


A Tough Nut to Crack

Back in the day, eating nuts meant cracking nuts.

It was common to see living room tables with bowls of nuts in their shell, with nutcrackers and nut-picks readily available for use.

Each house had its preference for the style of nutcrackers they insisted were the best.  Growing up, we had ones like those above.

Nuts and “Carb Creep”

“Carb creep” is when we think we are eating low carb, but hidden sources of carbs are sneaking into our diet without us being aware of it.

When I was pondering why I had reached my own weight plateau, I knew carb creep had to be the reason – but from where?

After analyzing my diet, it seemed that nuts might be the source and it was.

My biggest single downfall was that I like to crack and eat pistachios on the weekend, while working on my foreign language studies – and it is WAY too easy to crack them and eat copious amounts!  In fact, I am somewhat of an expert at shelling them, as my brother and I were placated by our parents with bags of pistachios, on long car trips. To get my “fair share”, I learned to be quite efficient at shelling them and so it seems, I haven’t lost that ‘skill’.

Over the course of several hours I can shell and eat 1/2 to 1 lb of pistachios without really noticing eat, and in the worst case scenario that’s almost 100 gms of hidden carbs!

Add to that a handful or two of almonds a day (another hidden 10 gm of carbs per day) and the source of my “carb creep” became clear.

Portioning

Of course to try to prevent eating too many, nuts can be portioned out in 1 oz or 3 oz ‘servings” and the rest put away for another time, but it is still way too easy for someone who is hungry or tired to mindlessly reach for a handful or two of nuts. It seemed to me that having large containers of shelled nuts that are too easy to reach for, may not be the best solution.

Unshelled Nuts

Replacing shelled nuts with nuts in the shell, like we ate in the “old days”, turns out to be a far more effective solution.

It’s very hard to over eat nuts you have to shell first.

It is much s-l-o-w-e-r to crack and then eat these almonds than these: 

 

…or to crack and eat these Brazil nuts  than these: 

Bingo!

Since pecans are a much lower carb nut than pistachios, they have become my go-to nut from the nut-bowl…and let me assure you, it takes quite a while to shell 17 halves for a mere 1.3 carbs! In fact, I’m pretty sure I expend more energy cracking them, than I take in, eating them.

The Right Tools for the Right Job

Despite having a variety of nutcrackers, I found pecans a “very tough nut to crack” – with them frequently flying out of the standard pinch-style cracker.

I found out that there is a special “pecan cracker” that one can order that apparently does the job very well and looks like this:

…but the little contraption below that I invented in my garage (with a d-clamp and a stick-on felt pad, works great, and I use it for pecans, walnuts and even hazelnuts. Even eating walnuts, which are a higher carb nut – it takes quite a while to shell 9 halves (2  1/2 gms of carbs).

How I can help

For the last 2 years, I have helped my clients lose weight and keep it off using a low-carb approach. More recently, I am ‘practicing what I preach‘ (as you can read about in the blogs titled “A Dietitian’s Journal”). The things I am learning “doing it” adds to what I know academically – which makes me able to coach people much more effectively.

Have questions?

Why not send me a note using the “Contact Us” form on the tab above.

To our good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2017 The Low Carb High Fat Dietitian (a division of BetterByDesign Nutrition Ltd).  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 

 

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1977 Dietary Recommendations — forty years on

Since 1977, the dietary recommendations in Canada and the US has been for people to consume a diet with limited fat and where “complex carbohydrates” (starches) comprise the main source of calories.

From 1949 until 1977, the dietary recommendations of Canada’s Food Guide were for people to consume

~20-30% of their daily calories as carbohydrate

~40-50% of daily calories as fat

~20-30% of daily calories as protein

From 1977 onward, Canada’s Food Guide recommended that people consume:

55-60% of daily calories as carbohydrate

<30% of daily calories as fat, with no more than 1/3 from saturated fat

15-20% of daily calories as protein

The US recommendations since 1977 have been similar to those in Canada, with the Dietary Goals for the United States recommending that carbohydrates are 55-60% of daily calories and that calories from fat be no more than 30% of daily calories (of which no more than 1/3 comes from saturated fat).

Eating Well with Canada’s Food Guide which came out in 2015, recommends that people eat even more of their daily calories as carbohydrate;

45-65% of daily calories as carbohydrate

20-35% of daily calories as fat, with no more than 1/3 from saturated fat

10-35% of daily calories as protein

[Reference: http://www.hc-sc.gc.ca/fn-an/nutrition/reference/table/ref_macronutr_tbl-eng.php]

Health Canada recommends limiting fat to only 20-35% of calories  while eating 45-65% of daily calories as carbohydrates and currently advise adults to eat only 30-45 mL (2 – 3 Tbsp) of unsaturated fat per day  (including that used in cooking, salad dressing and spreads such as margarine and mayonnaise).

This is what people have come to call a “balanced diet“.

But is it?

For the past 40 years, the public has come to believe that ‘eating fat made you fat’ and that eating saturated fat caused heart disease. Evidence-based research does not seem to support that having a diet rich in healthy fats – especially monounsaturated fats like from olive and its oil, and avocados, nut and seeds and omega 3 fats from fish causes heart disease.

Our society has become “fat phobic”. People guzzle skim or 1% milk with little regard to the fact that just 1 cup (250 ml) has almost the same amount of carbs as a slice of bread.  And who drinks only one cup of milk at a time?  Most people’s “juice glasses” are 8 oz and the glasses they drink milk from are 16 oz, which is 2 cups. Who ever stops to think of their glass of milk as having the same amount of carbs as almost 2 slices of bread?

In addition, carbs are hidden in the 7-10 servings of Vegetables and Fruit they are recommended to eat  – with no distinction made between starchy- and non-starchy vegetables.  Many people eat most of their vegetable servings as carbohydrate-laden starchy vegetables such as peas, corn, potatoes and sweet potatoes and then have a token serving of non-starchy vegetables (like salad greens, asparagus or broccoli) on the “side” at dinner. Who stops to think that just a 1/2 cup serving of peas or corn has as many carbs as a slice of bread – and often those vegetables are eaten with a cup of potatoes, adding the equivalent number of carbs as another 2 slices of bread?

People drink fruit juice and “smoothies” with no regard for all of the extra carbs they are consuming (not to mention the effect that all of that fructose has).  A “small juice glass” is 8 oz, so just a glass of orange juice has the equivalent number of carbs as another 2 slices of bread! Many grab a smoothie at lunch or for coffee break without even thinking that the average smoothie has the same number of carbs as 5 slices of bread!

Then there is the toast, bagels and cereal or bars that people eat for breakfast, the sandwiches or wraps they eat for lunch and the pasta or rice they have for supper.  These are carbs people know as carbs — which are added to all the carbs they consumed as vegetables, fruit and milk.

What has been the outcome of people following these dietary recommendations to eat a high carb diet since 1977 ?

Obesity Rates

In 1977, obesity rates* were 7.6% for men and 11.7% for women, with the combined rate of < 10 % for both genders.

* Obesity is defined as a Body Mass Index (BMI) ≥30 kg/(m)2

In 1970-72 the obesity rate in Canadian adults was 10% and by 2009-2011, it increased two and a half times, to 26%.

In 1970-72, only 7.6% of men were obese but by 2013, 20.1% of men were categorized as obese. In 1970-72, only 11.7% of women were obese but by 2013, 17.4% of women were obese.

In 1978 in Canada, only 15% of children and adolescents were overweight or obese, yet by 2007 that prevalence almost DOUBLED to 29% of children and adolescents being overweight or obese. By 2011obesity prevalence alone (excluding overweight prevalence) for boys aged 5- to 17 years was 15.1% and for girls was 8.0%.

The emphasis since 1977 on consuming diets high in carbohydrates and low in fat has taken its toll.

Effect on Health

Non-alcoholic liver disease is rampant and not surprisingly, considering 37% of adults and 13% of youth are abdominally (or truncally) obese – that is, they are carrying their excess body fat around and in the internal organs, including the liver.

Since the 1970’s, Diabetes rates have almost doubled.

  • In the 1970s, the rate of Type 2 Diabetes in women was 2.6% and in men was 3.4 %. In the 1980s that number rose in women to 3.8% and in men to 4.5%. In the 1990s the rate was almost double what it was in 1970; in women it was 4.7% and  in men, 7.5%.

If people eating a high carb, low fat diet has corresponded to an increase in obesity, overweight and Diabetes, then what’s the alternative?

That is where a low carb high healthy fat diet comes in , which supplies adequate, but not excess protein. It enables us to use our own fat stores for energy, and to make our own glucose (for our blood and brain) with ketones (that are naturally produced by our bodies when we sleep, for example) to fuel our cells and organs. Since humans are designed to run on carbs (in times of plenty) and in our fat stores (when food is less plentiful), being in mild ketosis is a normal physiological state. By eating a low carb high fat diet when we’re hungry and delaying eating for short periods, we can mimic the conditions that were common to our ancestors. By eating this way over an extended period of time, we can bring down insulin levels and as a result, decrease the insulin resistance of our cells. We can improve our blood sugar, lower our blood pressure and see our LDL cholesterol and triglycerides come down to normal, healthy levels.

Want to know more? Why not send me a note using the Contact Us form located above?

To your health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

 

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What is a Low Carb High Fat Ketogenic Diet?

A low carbohydrate high fat ketogenic diet supplies adequate, but not excess protein and low levels of carbohydrate that is naturally found in foods such as non-starchy vegetables, nuts and seeds, and certain fruit. A low carb high fat ketogenic diet enables our bodies to burn our own fat stores quite efficiently for energy, while making the glucose needed by our blood and brain, and using ketone (which our body naturally produces as we sleep) for energy for our cells and organs.

Note: Not all low carb diets are ketogenic diets.  There are many types of low carb diets, ranging from moderately low carb diets (130 g carbs) to ketogenic diets (5-10% net carbs) and everything in between. As well, not all low carb diets are high fat diets. Some approaches are low carb higher protein diets and are also ketogenic, because carbs are limited. More on those in a later article. This article is only about a low carb high fat ketogenic diet.

Ketogenic Macronutrient Ratio

Generally speaking, in a low carb high fat ketogenic diet, the percentage of calories (kcals) from carbohydrate (carbs), protein and fat in a ketogenic diet (called the macronutrient ratio) is as follows;

65-75% of calories from fat

~20% of calories from protein

5-10% of calories from NET carbs (which is the carbohydrate in food, minus the insoluble fiber found in that food)

While each person’s energy needs and macronutrient needs are different (based on their age, gender and activity level, as well as any pre-existing medical conditions they may have), most people on ketogenic diets take in 10% or less of their calories from net carbohydrates*, with the amount of fat and protein intake varying from person-to-person within the above range.

* Net carbs are determined by subtracting insoluble fiber contained in food from the carbohydrate content of that food.

By eating low levels of carbohydrate, insulin level falls and glucagon and epinephrine levels in the blood rise.

This causes several things to occur;

  1. Fat stores are burned for energy
    The fat stored in fat cells (called adipocytes) are released into the blood as free fatty acids and glycerol. Since fatty acids contain a great deal of energy, they are broken down in cells that have mitochondria in a sequence of reactions known as β-oxidation, and acetyl-CoA is produced. This acetyl-CoA then enters the citric acid cycle where the acetyl group is burned for energy.


  2. Glucose is made for energy
    When insulin levels are low (or absent) and glucagon levels in the blood are high, glucose is produced via gluconeogenesis (literally, the “making of glucose”) and then released into the blood and used as an energy source. As elaborated on below, while the brain can use ketones for fuel, it has a need for some glucose.


  3. Ketones are produced for energy
    In significant carb restriction over several days, gluconeogenesis is stimulated by the low insulin and high glucagon levels results in acetyl-CoA being used for the formation of ketones (i.e. acetoacetate and beta-hydroxybutyrate and their breakdown product, acetone). These ketones are released by the liver into the blood where they are taken up by cells with mitochondria and reconverted back into acetyl-CoA, which can then be used as fuel for energy, in the citric acid cycle. Ketones can cross the blood-brain barrier, so they are used as fuel for the cells of the central nervous system – acting as a substitute for glucose (which is normally the end result of the body breaking down carbs and sugars found in various foods). After ~ 3 days on a very low carb diet, the brain will get ~ 25% of its energy from ketones and the other 75% from the glucose made via gluconeogenesis.  After ~ 4 days the brain will get about 70% of its energy from ketones. While the brain can use ketones for some or even most of its fuel, it still has requirement for some glucose and that is supplied from gluconeogenesis. The heart ordinarily prefers to use fats as fuel but when carbs are restricted, it effectively uses ketones.

    Ketosis versus Ketoacidosis

    Ketones are naturally produced during periods of low carb intake or in periods of fasting and during periods of prolonged intense exercise. This state is called ketosis. Since the human body is designed to use glucose as a fuel source (in times of plenty) and to use fatty acids and ketones (in times of food shortage), ketosis is a normal, physiological state.

    In untreated (or inadequately treated) Type 1 Diabetics (where the beta cells of the pancreas don’t produce insulin), the ketones that are produced are as the first stage of a serious medical state called ketoacidosis.

    Ketosis, on the other hand is a normal, naturally occurring state that occurs naturally when we sleep for example or miss a meal, whereas ketoacidosis is a serious medical state associated most commonly associated with Type 1 Diabetes. While often confused, these two conditions are very different.

A Low Carb High Fat Ketogenic Diet

A low carb high fat ketogenic diet may appear at first glance to be like the Atkins diet or other low carb high fat diets but the main difference is that in a keto diet, protein is not unlimited. The reason for this is based on the premise that excess protein will be converted into glycogen and have a similar effect on ketosis as eating too many carbs, disrupting ketosis.

Since having too little protein may cause muscle loss, a keto diet is designed to have adequate, but not excess protein.

But why eat a low carb high fat keto diet?

The last 40 years of burgeoning rates of overweight, obesity and Diabetes, provide the motivation. (Please read the next article titled 1977 Dietary Recommendations — forty years on for a summary of those issues).

A low carb high fat keto diet is one low carb approach that is used for clinical reasons, such as to seek to reverse the symptoms of Diabetes by enabling insulin levels to fall, glucagon and epinephrine levels to rise, resulting in the body:

(1) naturally accessing its own fat stores for fuel

(2) manufacturing its own glucose

and

(3) using ketone bodies for energy.

The human body is designed to use either glucose or fatty acids and ketones as a fuel source. Ketosis is a normal, physiological state where our bodies run almost entirely on fat.

Insulin levels become very low, which has benefit to those who are insulin resistant or Type 2 Diabetic. 

As a result, burning of our own body fat stores for energy increases dramatically — which is great for those who want to lose weight, without hunger and a steady supply of energy.

Want to know more?

Feel free to send me a note using the Contact Me form, above.

To your health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status are different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

 

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Humans – the perfect hybrid machine

Long before the ‘hybrid car” there was the human body – a hybrid ‘machine’ perfectly designed to use either carbohydrates or fat for energy. Like a hybrid car, we can run on one fuel source or the other at any one time.

If we are eating a largely carbohydrate based diet, we will be in ‘carbohydrate mode’ by default. Carb-based foods will be broken down by our bodies to simple sugars and the glucose used to maintain our blood sugar levels. Our liver and muscle glycogen will be topped up, then the rest will be shuttled off to the liver where it will be converted into LDL cholesterol and triglycerides and stored in fat cells.

Historically, in times of plenty, we’d store up glycogen and fat and in lean times, we’d use up our glycogen and then switch fuel sources to be in “fat-burning mode” — accessing our own fat stores, for energy.

The problem is now that we rarely, if ever access our stored fat because we keep eating a carb-based diet.  So we keep getting fatter and fatter.

GLUCOSE OR FAT AS FUEL

When we are in “carb burning mode”, the carbs we eat are broken down by different enzymes in our digestive system to their simplest sugar form (monosaccharides) such as glucose, fructose and galactose.

Glucose is the sugar in our blood, so starchy foods such as bread and pasta and potatoes are broken down quickly so they are available to maintain our blood sugar levels.

Monosaccharides are the building blocks of more complex sugars such as disaccharides, including sucrose (table sugar) and lactose (the sugar found in milk), as well as polysaccharides (such as cellulose and starch). When we drink milk for example, the galactose found in it is broken down into lactose and glucose.  When we eat something sweetened with ‘sugar’ (sucrose), it is quickly broken down to glucose and fructose.

Any glucose that is needed to maintain our blood sugar level is used immediately for that purpose and the remainder is used to “top up” our glycogen stores in our muscle and liver. There are only ~ 2000 calories of glycogen – enough energy to last most people one day, so when our glycogen stores are full, excess energy from what we eat is converted to fat in the liver and stored in adipocytes (fat cells).

One problem is that most of our diets are high in fructose – naturally found in fruit but also as high fructose corn syrup in many processed foods. Fructose can’t be used “as is”, so it is brought to the liver.  If our blood sugar is low, it will be used to make glucose for the blood (via gluconeogenesis) otherwise it will be converted into LDL cholesterol (so-called “bad cholesterol”) and triglycerides and stored as fat.

Feasting and Fasting

When we don’t eat for a while, such as would have occurred when our ancestors were hunter-gatherers, we’d use up our glycogen stores hunting for an animal to eat, or gathering other edible foods and if we weren’t successful at finding food to eat, then our bodies would access our fat stores, for energy.  This is known as lipolysis. This process is regulated mainly by a hormone called glucagon, but other hormone such as epinephrine (the “fright and flight” hormone), cortisol (the “stress hormone”) as well as a few others (ACTH, growth hormone, and thyroxine) also play a role.

In times of plenty, we’d store up glycogen and fat and in lean times, we’d use up our glycogen, switch into “fat-burning mode” and then rely on our stored fat for energy.

The problem for most of us in North America and Europe is that we have access to food in our homes, in stores and at fast food restaurants 24/7. We can’t go for a walk without passing places selling or serving food and if the weather is bad or we are too tired, food is just a phone call or web-click away. So we just keep storing up our fat for ‘lean times’ that never come.

In addition, irrespective of our cultural background, our eating style is carb based; pasta, pizza, sushi, curry and rice or naan, potato, pita – you name it.  Every meal has bread or cereal grains, pasta, rice or potatoes – and even what we consider “healthy foods” such as fruit and milk have the same number of carbs per serving as bread, cereal, pasta, rice and potatoes. That wasn’t always so. Our indigenous cultural foods were very different.

Compounding that, many “low-fat” products have added sugar (sucrose) in order to compensate for changes in taste from reducing naturally occurring fat, which then adds to excess carb intake.  Sucrose (ordinary table sugar) is made up of half fructose, so a diet high in sugar adds even more fructose transport to the liver, for conversion to cholesterol and fat.

The vilification of fat

In 1977, both the Canadian and US food guides changed in response to the promoted belief that eating diets high in saturated fat led to heart disease. Multiple studies and reanalysis of the data of older studies indicates that saturated fat is not the problem, but that diets high in carbohydrate combined with chronic inflammation and stress, is.

In 2016, it came to light that the sugar industry funded the research in the 1960’s that downplayed the risks of sugar in the diet as being related to heart disease and highlighted the hazards of fat instead – with the results having been published in the New England Journal of Medicine in 1967 with no disclosure of the sugar industry funding*. The publication suggested that cutting fat out of the American diet was the best way to address coronary heart disease, and which resulted in the average American and Canadian as inadvertent subjects in an public health experiment gone terribly wrong. Overweight and obesity has risen exponentially and with that Diabetes, hypertension (high blood pressure) and high cholesterol.

*(Kearns CE, Schmidt LA, Glantz SA. Sugar Industry and Coronary Heart Disease Research A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016;176(11):1680-1685. doi:10.1001/jamainternmed. 2016. 5394). 

Over the last 40 years the promotion of “low fat eating” by governments and the food industry has resulted in carbohydrate-intake skyrocketing. Every high-carb meal is followed by another high-carb meal, and if we can’t wait, a snack, too. We eat every 2-3 hours, and eating carb-based foods every 2 or 3 hours all day, every day is quite literally killing us.

How do we get fat out of “storage”?

The “key” to unlocking our fat stores, is decreasing overall intake of carbohydrates by decreasing the amount of carbohydrates we eat, both by eating much less of it and on occasion, by delaying the amount of time between meals.

Decreasing carb intake lowers insulin, the fat-storage hormone. At first our bodies access liver and muscle glycogen for energy, but since that is only about a one day’s supply, our bodies then turn to our own fat stores as a supply of energy.

By eating a diet rich in fat and keeping protein at the level needed by the body but not in excess, dietary protein is not used to synthesize glucose, but fat is.

An added bonus is that since insulin also plays a role in appetite, as insulin falls, appetite decreases.

This is the role of a low carb high healthy fat diet, a topic covered in this article.

Have questions?

Why not send me a note, using the “Contact Me” form above?  I’d be happy to answer your questions.

To your health!

Joy

If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

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The Limitations of Common Ways of Determining Weight Loss

People who are eating differently in an effort to lose weight often hop on the scale daily to see how they’re doing. What they fail to consider is that an average adult’s body weight can fluctuate by as much as 4  1/2 pounds per day — solely as a result of changes in the amount of water they are retaining or excreting.

The Limitations of Using a Scale to Determine Fat Loss

An 80 kg person has, on average 48 liters of water in their body. The problem with using body weight as an assessor of fat loss is that the human body does not precisely regulate body water content.

Above 49 liters of water, the kidneys of an 80 kg person will clear the excess water by causing the person to urinate more and below 47 liters of water, the 80 kg person will feel thirsty and increase their fluid intake. People’s “weight” is affected by this change in body water content of ~2 liters per day — which weighs approximately 2 kg or 4.4 pounds! Put another way, each day our “weight” can fluctuate by this amount solely due to the difference in retained or excreted water.

Since there is no way to measure this daily change in water weight in non-clinical settings, the standard scale is a very imprecise way to measure fat loss over the short-term.

Waist Circumference

Many people know that carrying excess weight around the middle increases one’s risk of cardiovascular disease, including heart attack so they measure their waist circumference frequently. Even if waist circumference is measured halfway between the lower rib and the top of the hip bone, with a fully relaxed abdomen, their are limitations to using this as a short term measure of weight loss.

The Limitations of Using a Tape Measure to Determine Fat Loss

Since the average person’s body weight fluctuates by as much as ~4 1/2 pounds per day due only to changes in body water, a tape measure fails to capture decreases in waist circumference stemming from the kidneys excreting water.

That said, waist circumference is helpful as a long-term indicator of weight loss, just not a short-term one.

Body Fat Percent

Some people have bathroom scales that have body fat analyzers built in and think that what it is measuring is the amount of fat they are carrying, however a number of factors can influence this reading.

The Limitations of Using a Body Fat Analyzer to Determine Fat Loss

Body Fat Analyzers use electrical impedance to determine fat percentage, and this measurement is affected by a number of conditions, including environmental (room) temperature, a person’s hydration status, as well as emotional stress. Since hydration status can fluctuate by ~4 pounds per day, a body fat analyzer is no more accurate as a short-term measure than a standard bathroom scale, without it.

How to assess short-term weight loss

How one’s own clothes fit and comparative ‘before’ and ‘after’ photos are a much better short-term assessor of fat loss than a scale, a tape measure and a body fat analyzer. Since body water fluctuates considerably on a low carb high fat diet due to changes in sodium levels, I recommend that people eating a low carb high fat diet weigh themselves once every two weeks on the same day of the week, at the same time of day and measure their waist circumference at the same time. If they have a scale that assesses body fat percent once every two weeks is sufficient for taking these measurements.

None of these will provide much information on actual fat loss over the short term…so why rely on them for that, but they will be helpful measurement over the longer term.

Sodium and Body Water Content

As mentioned in a previous article, by eating only when hungry and only until no longer hungry, insulin levels have the opportunity to fall to baseline – something they do naturally after not eating for 12 hours.

On days where the time until eating is extended by a few hours (i.e. “intermittent fasting”), insulin levels stay low for an even longer period of time.  In response, our kidneys excrete sodium in a process called naturesis.

Failing to supplement sodium while eating low-carb high fat can result in intense headaches – and if sodium remains low, potassium will also be excreted to keep the necessary sodium-potassium balance. This drop in potassium often results in irregular heart beats, known as arrhythmia.

Phinney and Volek (The Art and Science of Low Carbohydrate Living) recommend that if one is eating less than 60 gms of carbs per day, that 2-3 grams of sodium should be added to the diet (provided the person is not taking any diuretics or other blood pressure medication).

A half a teaspoon of table salt or sea salt provides 1000 mg or 1 gram of sodium.

Final Thoughts

Since hopping on the scale daily or even several times a week won’t provide any useful information, nor will measuring our waist circumference or using a body fat analyzer too often – why do it? Part of ‘getting healthy’ ought to include having a healthy body self image – something that won’t be nurtured by obsessing about such “numbers”.

Short-term measures of success

Short-term success is best measured visually – with comparative photos taken from the same distance away, from the same relative height and wearing the same clothing.

How one’s clothes are fitting is another way.

A person who is insulin resistant or Type 2 Diabetic should be seeing both their fasting blood glucose and post-prandial (2 hours after a meal) glucose levels gradually coming down. If they aren’t then they should schedule an appointment with their Dietitian to find out why that is.

Medium-term measures of success

Medium-term measures of success in eating low carb high fat can be measured both subjectively and objectively. Subjective measures include weighing oneself and taking one’s own waist circumference once every two weeks. Objective measures include having your Dietitian weigh you on a clinical scale, having her assess your waist circumference and body fat percentage using both a device that measures electrical impedance, as well as using good old-fashioned calipers, that measure subcutaneous (under the skin) fat, in 3 or four specific locations on the body.

A person with high blood pressure should be seeing both systolic (the first number) and diastolic (the second number) blood pressure coming down and Type 2 Diabetics or those with insulin resistance should be continuing to observe lower fasting blood glucose and post-prandial (2 hours after a meal) glucose levels.

Longer-term measures of success

After 6 or 8 months eating low carb high fat, both subjective and objective measures should be continuing to lower in a reasonably linear fashion. Of course there will be times where a ‘plateau’ is reached, but if that lasts more than two or three weeks, then its important to check in with your Dietitian to make sure the amount of carbs you think you are eating is what your Dietitian has been determined as being best for you.

A Type 2 Diabetic should be seeing both their fasting blood glucose and post-prandial (2 hours after a meal) glucose levels approaching more normal levels and both Type 2 Diabetics and those with insulin resistance (“pre-diabetes”) should have their HbA1C assessed at a lab every three months, as this provides insights into one’s 3-month average blood glucose level. Fasting blood glucose provides a ‘snap-shot’ of blood sugar in the morning after not eating, and should be done twice a year by a lab, especially if one is Diabetic. Comparing lab test results to previous lab test results is an objective indicator of the effect that eating low-carb high fat is having on specific markers and provides an opportunity to determine if the amount of carbs being eaten may still be too high.

The most accurate assessor is a 2 hour glucose tolerance test, however few doctors will requisition this after one is diagnosed as Type 2 Diabetic.

Finally, every year or so, it is helpful for those who have been diagnosed as Diabetic to have their fasting insulin, C-Protein and AM Cortisol levels assessed and compared to previous results. For these, your doctor may refer you to an Endocrinologist.

Remember, achieving health is a journey and takes time and like most journeys, it is best not done alone.

Have questions about how I can help or about the services I provide?

Please send me a note using the form on the “Contact Us” tab, above.

To your good health!

Joy

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.


follow me at:
 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/


 

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From Paleo to Present – a brief history of the human diet

Prior to the domestication of animals and the development of agriculture, the human diet centered around the ‘hunt’. They ate when they caught something, and didn’t eat until again until they either caught something else, or were successful in finding edible vegetation, berries or nuts. “Feasting” and “fasting” were normal events in the rhythm of life, and our bodies were designed to function using our fat stores for energy, as evidenced by our continued existence.

From hunter-gatherers to farmers

After the Ice Age, those that survived were left with an increasingly unpredictable climate, decreases in big-game species that were hunters’ first-choice prey, and increasing human population in the available habitats for hunting and gathering. To decrease the risk of unpredictable variation in food supply, people broadened their diets to second- and third-choice foods, which included more small game, plus plant foods which required much preparation, such as grinding, leaching and soaking. As I will demonstrate below, these plant foods, including grains were very different in carbohydrate and protein composition than they are today.

The domestication of animals and plant cultivation of ~ 13,000 years ago, forms a significant turning point in the human diet.

Humans began to transport some wild plants, including grains from their natural habitat to more productive selected habitats, and so began intentional cultivation, or farming. With the development of agriculture and the domestication of animals – the plants and animals themselves began to change.

This is important.

The fruit of today bear little resemblance to their ancient predecessors. The grains of today don’t either. For example, wild wheat and wild barley bear their seeds on top of a stalk, and sheds its seed spontaneously – enabling it to germinate where it falls.

Once people began bringing some wild wheat or barley seeds back with them in order to intentionally plant them, some seeds would accidentally spill along the way, germinating in new places. Over time, some seed would cross-pollinate with wild grain, while others would undergo spontaneous mutations, leading to wheat and barley varieties with non-self-shattering heads. Eventually, these non-shattering grains were selected for by humans for cultivating, leading to a very different type of grain than the wild species – and one with very different nutritional content than their wild predecessors.

Similarly, domesticated animals were selected based on traits that were considered desirable to people – chickens were selected to be larger, wild cattle to be smaller, and sheep to lose their bristly outer hairs and not to shed their soft inner wool. Eventually, the land where hunter-gatherers lived was overrun and replaced by people who had become agricultural – and who were ever-expanding the amount of land they required for raising animals, as well as for growing crops.

At Tell Abu Hureyra, in the Euphrates valley of modern Syria are the remains of a civilization that lived between 13,000 and 9,000 years ago, spanning the Epipaleolithic and Neolithic periods. This site is significant because the inhabitants of Abu Hureyra started out as hunter-gatherers, but gradually moved to agriculture, making them the earliest known farmers in the world. Meals consisting of the meat of gazelle, wild goat and game birds were supplemented with wild-growing Einkorn wheat-porridge, as well as berries, nuts or fruit, if in season.  Tools such as sickles and mortars for harvesting and grinding grain, as well as pits for storing it have been found at Tell Abu Hureya and remains of harvested Einkorn wheat (which was ground by hand and eaten as porridge) have been found at Tell Aswad, Jericho, Nahal Hemar, Navali Cori and other archeological sites.

The diet of man forever changed at that point.

As previously mentioned, plants underwent change as a result of both natural cross-pollination as both underwent change as a result of intentional manipulation by man.  This occurred everywhere that man settled – from the lush valleys of the Middle East*, to Africa and Asia.

[*yes, the Fertile Crescent of the Middle East was lush and green, then.]

The grain we know today as “wheat” and “rice” is nothing like their wild ancient predecessors. Likewise with fruit. The fruit of today has been bred to be sweet – not so with the wild cultivar. A brief history of wheat will help illustrate this type of change.

Evolution of Wheat – but one example

The first wild grass that was cultivated was Einkorn wheat. As cultivation techniques improved, Einkorn eventually became an essential component of the dietreducing the need for hunting and gathering. Einkorn wheat contained only 14 chromosomes.

Shortly after the cultivation of the first Einkorn, the Emmer variety of wheat (Triticum turgidum) appeared in the Middle East; a natural offspring of Einkorn and an unrelated wild grass, calledgoatgrass(Aegilops speltoids.

Emmer wheat is what is referred to in the Hebrew Bible (Exodus 9, Exodus 32, Isaiah 28, Isaiah 25) as Kes-emmet (כֻּסֶּמֶת) and both Eikorn wheat (חִטָּה) and “Emmet” (ֻּסֶּמֶת), translated in English as ‘spelt’, are referred to together as distinct species (e.g. Exodus 9:32).  It was the ancient Egyptians that are credited with the addition of wild strains of yeast in order to make bread rise – which gives an added dimension to the story of Passover, where the Jews left slavery in Egypt in “great haste”, “not having time to let their bread rise”.

Since plants do not combine genes but add (or sum) them which provides evidence of what cross-bred with what. Goatgrass added its genetic code to that of Einkorn , so Emmer wheat had 28 chromosomes.

Emmer wheat then naturally cross-bred with another wild grass called Triticum taushii, giving rise to the original cultivar of Triticum aestivum, the predecessor of modern wheat, which has 42 chromosomes. This was a higher yielding wheat variety which had many desirable baking properties that Eikorn and Emmer lacked.  This new strain remained largely unchanged until the mid-eighteenth century when Carolus Linneaus, who invented the Linnean system of categorizing species, counted only 5 species.

Today, Eikorn, Emmer and the original cultivated strains of Triticum aestivum have been replaced by almost 25,000 strains of modern human-bred wheat strains that are hundreds, if not thousands of genes apart from the original Eikorn and Emmer wheat species.

Our food is not the food of our ancestors.

Modern Triticum aestivum is on average 70% carbohydrate by weight and only 10% protein. Emmer wheat, on the other hand was 57% carbohydrate and 28% protein – and was suitable to supplement the protein of a meal.

Paleo Diet compared with the Low Carb High Healthy Fat diet

The premise of Paleo eating to eat like our Paleolithic ancestors did is understandable, however the foods that exist now are nothing like the foods our ancient ancestors ate. Fruit, for example is considered “paleo” -but the carb content of paleo fruit was substantially less than that of today.

In a low carb high healthy fat way of eating, carbs are not avoided. It is the foods that are high in carbs that are easily broken down to glucose and have little nutrient-density that are limited.

[It is hard to justify eating grain products made from varieties of wheat that were bred for no other reason than they could be grown in nutrient- poor soils in novel parts of the world.]

No justification is needed to eat carbs that come as part of fibre- and nutrient-rich non-starchy vegetables and to eat carbs found in nuts that are a good source of protein and monounsaturated fat.

A diet where 45 – 65% of calories are as carbohydrate is has us eating “carbs for carb’s sake”, but a low carb high healthy fat diet should not be about “fat for fat’s sake”.

Some people think they should eat large amounts of saturated fat “just because they can”, and I suppose that’s true. One can certainly eat a pound of bacon, but when compared  with a fat marbled grain-fed steak or a Brome Lake- or wild duck, one is more nutrient-dense than the other. The yolks of free-range egg comes as part of a nutrient-dense package, which includes good quality protein, as well as other nutrients. A pound of bacon, does not. That doesn’t mean that eating bacon is “bad”, but in comparison to grilled salmon with a large serving of non-starchy vegetables bathed in cold-pressed olive- or avocado oil, it doesn’t quite measure up. It is not just about not being hungry, but about being healthy.

A Low-Carb-High-Healthy-Fat Diet is about “nutrient density” – not just “fat density”.

Final Thoughts

In a Low-Carb-High-Healthy-Fat Diet, carbs are not “bad” and fat is not “good”. Carbs and fat that come in nutrient-dense food and in particular ratios are what we are striving for.

As well, protein quantity is based on physiological need and not unlimited (as excess in a low carb diet will be converted and stored as fat). The source of that protein ought to be considered, as well. For example, it is well documented that fatty fish such as salmon, mackerel and tuna are high in omega-3 fatty acids and are good for our brains and our hearts so for those that enjoy fish, eating it often is ideal.

The good thing about the Low-Carb-High-Healthy-Fat Diet is that it can be adapted to  culture- or religious restrictions. Don’t eat pork? No problem. Don’t eat beef? Not an issue. Take fast days? That is easily worked-in.

Want to know more?

Feel free to send me a note using the form on the “Contact Us” tab, above. Remember, Nutrition is BetterByDesign.

To your health!

Joy

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.


follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/


 

References

Binford LF. New Perspectives in Archaeology, 1968; 313–341

David, W. Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health Rodale Books, 2011; 15-32

Diamond J. Evolution, Consequences and Future of Plant and Animal Domestication. Nature, 2002; 418:700-7

Flannery KV. The Domestication of Plants and Animals, 1969;73–100

Hillman GC, Davies, MS. Measured Domestication Rates in Wild Wheats and Barley under Primitive Cultivation, and their Archaeological Implications. J. World Prehistory; 1990; 4:157–222

Raeker RO, Gaines CS, Finney PL, Donelson T. Granule size distribution and chemical composition of starches from 12 soft wheat cultivars. Cereal Chem 1998;75(5):721-8

Shewry PR. Wheat. J Exp Botany 2009;60(6):1537-53

Stiner MC, Munro ND, Surovell TA. The Tortoise and the Hare: small-game use, the broad-spectrum revolution, and Paleolithic demography. Curr. Anthropol. 41, 39–73 (2000).

Zohary D, Hopf M. Domestication of Plants in the Old World 3rd edn (Oxford Univ. Press, Oxford, 2000).

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Two People, Two Options: living healthy or dying prematurely

This weekend has been a challenging one, as I received two pieces of news. The first was of one client’s incredible success following the low carb high healthy fat diet and the shocked reaction of his doctor, and the other was of the death of a friend who had Diabetes, high blood pressure and high cholesterol. In this blog, I will share how these two events embody the two options each of us have; (1) living a healthy life to the fullest or (2) living with diet-related disease and dying prematurely of ‘natural causes’.

“JP” – a Picture of Success

Last fall, I had a reasonably fit 35-year-old client contact me wanting to lose 15 pounds. He went to the gym twice a week for an hour, and ran 10 km per week, but had put on some pounds and wanted to lose them.

As I always do, I asked for a copy of recent blood test, assessing his fasting blood glucose, HbA1C (3 month average of blood glucose), cholesterol (lipid panel) and requesting his doctor-assessed blood pressure. (Sometimes people insist that I counsel them without seeing blood work, but I explain that they ran out of crystal balls when I was graduating, so I have no choice but to get labs.)  I gave my new client a Lab Test Request form to bring his doctor.  The GP scoffed at the Lab Test Request Form asking him to requisition a lipid panel for a young, fit 35 year old whose parents are both living. That changed when the tests came back, and this man’s triglyceride level was higher than I had ever seen anyone’s, ever. His non-HDL cholesterol was very high and his HDL was very low. LDL wasn’t even available because his triglycerides levels were through the roof. His ferritin was astronomically high – not a sign of excess iron, but likely inflammation.

His doctor called him into the office immediately and wanted to put him on statin medication right away and referred him to the Lipid Clinic at a major local hospital.

My client told his doctor he wanted to wait 3 months and first follow my dietary recommendations and see what would happen to his lipids, and was advised against it by his doctor. My client was insistent, so the doctor told him that his recommendations were for him to eat “decrease saturated fat and carbohydrates, increase fruit and vegetables, increase insoluble fiber and fish, make his plate 1/2 vegetables, 1/4 protein, 1/4 starch“.

After seeing me, he agreed to limit fruit to max 1 / day, preferably a few berries on top of 2 or 3 huge salads with plenty of good quality olive oil and to have most of his carbs as vegetables. He learned that “not all vegetables are created equal” and I taught him to differentiate between those he could eat as much as he wanted at each meal and those he should limit or avoid. We talked about milk consumption, and the health benefits of eating plenty of fatty fish, such as salmon, mackerel and fresh sardine. And we talked about carbs. We talked a lot about carbs. Carbs in fruit, carbs in milk, carbs in bread, pasta and rice, and carbs in vegetables.

I designed an Individual Meal Plan for him, making sure he obtained sufficient macronutrients (protein, fat and carbs) as well as micronutrients (especially potassium, magnesium, sodium, vitamin C and calcium, vitamin D and vitamin K) – and factoring in his desired weight loss. I explained that if he followed his Meal Plan, it is perfectly reasonable for his triglyceride levels to be <2.00 mmol/L in 2 more months.

Three weeks later, his doctor ran his labs again.  His triglyceride level was almost a third what it was! His non-HDL was down substantially and his HDL was rising nicely. When he was seen at the Lipid Clinic, they were willing to give him 2 more months to get his lipids in the normal range before starting him on medication.

Friday, he wrote me telling me that his triglycerides we down well below 2.00 mmol/L and added;

“this amazed the doctor!”

My client left his doctor’s office without a medication prescription and with only the recommendation to keep eating the way I taught him. My client added that he was already within 2 – 3kg of his goal weight.

It’s not magic.

The doctor should not have been amazed that diet alone can be this effective – even for someone for whom high cholesterol has a genetic component. The literature documents the role of a low carb high fat diet.

But it is easier to write a prescription than educate a patient.

My High School Friend – preventable premature death

Last night I learned that my friend since high school, died from natural causes. She had Type 2 Diabetes, high blood pressure and high cholesterol. She and I were the same age.

Three years ago, when my friend was first diagnosed as having Diabetes, she asked my opinion about having received Diabetes counselling in her province to eat 45 gm of carbohydrates at each meal and at least 15 gm of carbohydrates at each of 3 snacks – that’s 180 gm of carbohydrates per day.  A mutual friend of ours from the same province, who had also been recently diagnosed with Diabetes confirmed that she too was advised to eat 45 gm of carbohydrates at each meal and at least 15 gm of carbohydrates at snacks. At that time, I had explained to my friend what I had been learning about the role of excess carbs in Diabetes, hypertension (high blood pressure) and high cholesterol. While I provide distance consultations in my practice (using a combination of phone, email and fax), as Dietitians we are advised specifically not to provide dietary counselling to family members or friends. With my ability to help directly being very limited, I recommended that she find a Dietitian near her who could teach her about managing this triad (called “metabolic syndrome”) using a low carb high fat diet. She followed the  standard dietary recommendations to the letter and took her multiple medications as prescribed. Her blood sugar levels came down using medication (but that was effectively treating the symptom of high blood sugar, not the cause which is the underlying insulin resistance). Her blood pressure kept going higher and higher despite medication, so more medication was added.  She then developed high cholesterol.

Today, my friend is dead, in what may have been an entirely preventable, premature death.

So I am left asking myself ‘could following the standard recommendations of eating 180 gm of carbohydrate per day (or more) with Type 2 Diabetes, high blood pressure and high cholesterol — without treating the underlying cause (insulin resistance) have contributed to her death’?

The literature is certainly full of studies documenting the beneficial effects of a low carb high fat diet on metabolic syndrome – but she was never given that as an option.  She was prescribed medication for lowering blood sugar and blood pressure, but nothing was done to lower her insulin resistance.

A lifetime of work by the late Dr. Joseph Kraft with almost 300,000 people documents that it is the insulin resistance that underlies cardiovascular disease – not the high blood sugar. Furthermore, 65-75% of people with normal blood sugar levels still have insulin resistance – and the same elevated risk of having a heart attack.

We keep treating the symptoms and people keep dying anyways – and those without any symptoms are walking around with elevated risk of dying from cardiovascular disease, and don’t even know it.

We are told;

“Diabetes is a chronic, progressive disease”

which means that once diagnosed with Diabetes, you’ll have it forever – and that eventually it will get worse, requiring medication, then more medication and finally insulin.

When people have bariatric surgery (“stomach stapling”), their blood sugars come back to normal within weeks and at the end of a year, they no longer have any of the clinical symptoms of Diabetes.  Their fasting blood glucose levels are normal and their HbA1C levels are normal. They are essentially as if they don’t have Diabetes. Their Diabetes is in remission.

So is Diabetes REALLY a “chronic, progressive disease”? No, it can be stopped.

If the reason people became Diabetic was because of how they were eating, why is it SO hard to grasp the concept that they could get well, but changing how they are eating?

At the end of the day, we have a choice.

We can do as my client above did and put everything we have into changing how we eat based on good, sound scientific studies and with medical supervision, or we can keep doing what we’ve been doing, expecting different results.

I made my choice a month ago tomorrow, and will write an update in the blog titled “A Dietitian’s Journey” tomorrow, for week four  (see Food for Thought tab, above).  Here’s a teaser; two days ago my blood sugar levels were several times at normal levels – and were overall much lower than a month ago. Last night (twice) and once this morning, my blood pressure was in the normal range.  One month!

I ask myself, what will my labs look like in 3 months or 6 months of addressing the underlying insulin resistance (instead of the symptom of high blood sugar?) What will be life be like, when I have normal blood sugar levels and normal blood pressure and normal cholesterol levels?

It will look better than the alternative.

Rest in peace, dear friend.

you can follow me at:

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Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.


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Significance of Insulin Resistance

Insulin resistance is a condition where your body keeps producing more and more insulin in order to transport glucose out of the blood and store the excess by converting it to fat. When cells have become resistant to insulin, glucose builds up in the blood and results in “high blood sugar”. The problem is that high blood sugar is a symptom of the problem, it is not the problem itself.  Insulin resistance is the underlying cause and is highly significant to those with completely normal blood sugar levels.

Those with high fasting blood glucose may notice symptoms that are associated with Type 2 Diabetes; including excess urination and excess thirst. This is the body’s way of trying to dilute the high levels of glucose in the blood. A very sobering fact is that 75% of people with insulin resistance have normal fasting blood glucose levels and don’t know that they are insulin resistant.

They have NO symptoms whatsoever.

They don’t know that they are at increased risk for heart attack and stroke.

The Silent Risk of Insulin Resistance

Insulin resistance is a risk factor for atherosclerosis* – also called “hardening of the arteries”. Atherosclerosis is where plaque builds up inside the body’s arteries and if the plaque build-up occurs in the heart, brain or kidney, it can result in in coronary heart disease, angina (chest pain) or chronic kidney disease. These diseases are normally associated with Diabetes, but it is the underlying insulin resistance of Diabetes that creates the increased risk – not the high blood sugar itself.  Worthy of note, it is being insulin resistance that increases one’s risk – whether or not one also has high blood blood sugar.

The plaque that builds up in atherosclerosis may partially block or totally block blood flow to the heart or brain and if a piece of the plaque breaks off or if a blood clot (thrombus) appears on the plaque’s surface – this can block the artery  resulting in a heart attack or a stroke (in the brain).

Three quarters of people with normal fasting blood glucose are at increased risk of atherosclerosis and as a result, to heart attack and stroke due to insulin resistance and they don’t even know it, because their blood sugar is normal!

* a few recent references (there are many more): Pansuria M, Xi H, Li L, Yang X-F, Wang H. Insulin resistance, metabolic stress, and atherosclerosis. Frontiers in Bioscience (Scholar Edition). 2012;4:916-931. Santos, Itamar S. et al., Insulin resistance is associated with carotid intima-media thickness in non-diabetic subjects. A cross-sectional analysis of the ELSA-Brasil cohort baseline, Atherosclerosis 2017 Mar 10;260:34-40

Insulin Resistance with Normal Blood Glucose

Dr. Joseph R. Kraft, MD was Chairman of the Department of Clinical Pathology and Nuclear Medicine at St. Joseph Hospital in Chicago, Illinois for 35 years. He spent a quarter century devoted to the study of glucose metabolism and blood insulin levels.

Between 1972 and 1998, Dr. Kraft measured the Insulin Response to a carbohydrate / glucose load in almost 15,000 people aged 3 to 90 years old using a 5-hour oral glucose tolerance test with insulin assays. Data from 10,829 of these subjects indicated that 75% of subjects were insulin resistant — even though their fasting blood sugar level was normal.

That is, having a normal fasting blood glucose level, and normal HbA1C level does not preclude someone from being insulin resistant and at increased risk for heart attack and stroke.

The American Heart Association states on its web page that;

“exactly how atherosclerosis begins or what causes it isn’t known, but some theories have been proposed. Many scientists believe plaque begins to form because the inner lining of the artery, called the endothelium, becomes damaged. Three possible causes of damage to the arterial wall are (1) elevated levels of cholesterol and triglycerides in the blood (2) high blood pressure and (3) cigarette smoking”.

It is known that high triglycerides in the blood are largely a result of diets high in carbohydrates where excess carbohydrate that isn’t converted to glycogen and stored in muscle and liver is stored as triglyceride (three fatty acids attached to a glycerol molecule).

Insulin resistance in our cells, results in our bodies releasing more and more insulin in order to try to clear the same amount of glucose from our blood to store it in our liver as triglyceride (fat!). As covered in the blog post on the hormonal effect of insulin, it is the insulin which drives increased hunger and specifically increased craving for carbohydrates.  A viscous circle is created.  Diets that are 45-65% carbohydrate result in more and more insulin to handle the same carb load (that is the very nature of insulin resistance) and this increased insulin leads to even more insulin resistance, increased hunger and craving for….you guessed it: more carbs.

Since insulin’s main role is to store the excess glucose not needed immediately to fat – our bodies produce more and more triglyceride (fat!) the more carbs we eat and the more insulin resistant we are. That is, a high carb diet results in high triglycerides – which the American Heart Association recognizes as playing a role in the development of atherosclerosis. That is because triglycerides are converted to VLDLs to transport fat around the body and when their triglycerides ‘passengers’ are depleted, what is left is LDL, the “bad cholesterol” we have all heard about.  The ONLY source of LDL is VLDL, and high triglyceride is largely the result of a diet that is too high in carbohydrate.

Insulin also plays a significant role in the regulation of blood pressure through its effect on sodium transport. As insulin rises, excess sodium is retained by the kidneys, increasing blood pressure.  Insulin resistance compounds this problem, causing blood pressure to rise even more.  It has long been known that people with Diabetes develop high blood pressure – but it is the underlying insulin resistance that is driving that, not the symptom of high blood sugar.

What is alarming is that based on Kraft’s research with ~11,000 people over 20 years, potentially 75% of people are insulin resistant — even though their fasting blood sugar level is normal. This insulin resistance drives the increased triglycerides and high blood pressure that characterize what the American Heart Associations states is believed what underlies the development for atherosclerosis – and the corresponding risk of heart attack and stroke.

Could insulin resistance be a silent killer?

Kraft’s Patterns of Insulin Response

Kraft plotted the data from ~11,000 subjects and five distinct Insulin Response Patterns emerged.

Insulin Response Curves – image adapted from Dr. Ted Naiman

‘Pattern I: is a normal, healthy insulin response to a standard glucose load. Dr. Kraft called this ‘Euinsulin’.

image by Joy Y. Kiddie MSc RD
Pattern I: Normal Insulin Response Curve

Pattern II – is a hyperinsulinemic insulin response to a standard glucose. Note that Pattern II is considerably greater than the normal insulin response curve (Pattern I) and this greater insulin response is sustained for 5 hours after the ingestion of the glucose. 

image by Joy Y. Kiddie MSc RD
Pattern II hyperinsulinemia compared to normal glucose response (Pattern I)

Superimposing the hyperinsulinemic insulin response of Pattern II over the normal Pattern I insulin response curve, it is easy to see how much higher the Pattern II (yellow curve) is over the normal Pattern I (green) curve.  This is the early stages of insulin resistance.


Pattern III – is a hyperinsulinemic insulin response to a standard glucose load. Compared to the normal insulin response curve (Pattern I), it much greater during for 5 hours after taking in the glucose.

image from Joy Y. Kiddie MSc RD
Pattern III hyperinsulinemia compared to normal glucose response (Pattern I)

Superimposing Pattern III (hyperinsulinemia) insulin response curve over the normal (Pattern I) insulin response curve, its easy to see how the insulin response is delayed (skewed to the right). This results in blood glucose remaining high, as insulin is not responding as it should. Keep in mind, this is occurring in people with normal fasting blood glucose levels.

The Pattern III curve also goes so much higher than the normal Pattern I insulin response curve – which means that more insulin is released and this higher insulin release is sustained for the 5 hours after taking in the glucose.

This is “silent” pre-diabetes – delayed insulin response and much higher levels of insulin for a much longer time – but with normal fasting blood glucose!

Pattern IV – Pattern IV is what Dr. Kraft calls “Diabetes in Situ” – literally “Diabetes in Place”. Looking at the Pattern IV insulin response curve compared to Pattern I (the normal insulin response), it is apparent that it is much greater for the entire 5 hours after taking in a standard amount of glucose.

image created by Joy Y. Kiddie
DIABETES IN-SITU: Pattern IV insulin response points compared to the normal Pattern I insulin response curve (in green)
image created by Joy Y. Kiddie MSc RD
DIABETES IN-SITU: Pattern IV insulin response curve compared to the normal Pattern I insulin response curve (in green)

Surprisingly, 40% of people with a Pattern IV Insulin Resistance still had normal fasting blood glucose.

75% of people displaying Pattern II, II or IV insulin responses do not know that they are at greater risk for atherosclerosis and as a result to heart attack and stroke because they have no symptoms.  Their blood sugar levels are normal.

Finally, insulin resistance is the most common cause of Type 2 Diabetes.

Normal fasting blood glucose and normal HbA1C results do not reveal whether or not a person is insulin resistant – only a 2 hr glucose tolerance test can do that. Unfortunately, a 2 hour glucose tolerance test is usually only requisitioned when fasting blood glucose and HbA1C results come back abnormal.

Potentially, up to 75% of people are insulin resistance and have NO IDEA!

They are at increased risk for heart attack and stroke and have NO SYMPTOMS.

They don’t have increased thirst or increased urination like Type 2 Diabetics, but are at the same risk.

The Good News

The good news is, we can lower insulin resistance – and as a byproduct of that, shed excess weight in the process. This is accomplished through (1) a low carbohydrate diet with or without the use of (2) stretching the amount of time between meals (sometimes called “intermittent fasting”).

When designed properly, a low carbohydrate diet can provide all of the recommended intake of vitamin and minerals – while lowering insulin resistance.

That is where I come in.

I can assess your physiological needs for energy and nutrients and design an Individual Meal Plan that will enable you to lose weight, without being hungry all the time – and that will help lower your insulin resistance and the associated risk of cardiovascular disease related to insulin resistance.

Want to know more? Click on the “Contact Me” tab above and send me a note.

To our good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

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Copyright ©2017 The Low Carb High Fat Dietitian (a division of BetterByDesign Nutrition Ltd).  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


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A LCHF Diet

A low carb high fat (LCHF) diet is a way of eating that maximizes the body’s natural ability to access one’s own fat-stores for energy. Fat takes the place of carbohydrate as the preferred source of energy, so most of the body’s energy needs comes from a wide variety of healthy fats. All low carb high fat diets minimize carbohydrate-based food, have a moderate amount of protein and high amount of healthy fats, some versions (e.g. Phinney and Volek) have higher protein and lower fat during the weight loss phase.

When we eat this way, our body uses dietary fat that we eat and our own stored fat for energy and by keeping carb intake low, insulin levels are allowed to fall, which in time makes our cells more sensitive to it. As insulin levels fall, so does hunger – so we eat meals when hungry, until we are no longer hungry – but are no longer hungry every few hours.

The low carb high healthy fat diet

These are the categories and types of food that are available to enjoy on a low carb high healthy fat diet;

Low Carb High Healthy Fat – food categories (acknowledgements: adapted from an illustration by Dr. Ted Naiman)

Macronutrients

The exact ratio of macronutrients in your diet (i.e. grams of carbs, fat and protein) will differ depending on your age, gender, activity level, current body composition as well as any health conditions or medication you may be taking – and of course, which style of low carb high fat diet you follow.

Here are some general guidelines to give you an idea;

Protein

A low carb high healthy fat diet does not have unlimited amounts of animal protein, although some variations of this style of eating do. As mentioned above, some versions of this eating style have higher amounts of protein than fat only during the weight loss phase.

Fat

One thing all low carb high fat diets have in common, is that they are lower in carbs than the conventional low fat calorie-restricted diet and high in fat.

During weight loss, some approaches have ~60% fat and higher amounts of protein, whereas others have 75-80% fat (e.g. Fung’s approach) and moderate amounts of protein.  But isn’t all this fat “bad” for us – especially saturated fat?

It’s important to keep in mind that only ~ 20% of the saturated fat in our body comes from diet, with the remainder being made by our body. If it were that ‘bad’ for us, why would our bodies naturally manufacture it?

How much saturated fat should we eat?

According to Phinney and Volek (The Art and Science of Low Carbohydrate Living), when someone is adapted to eating a low carb high healthy fat (i.e. are in “fat-burning mode”), saturated fats do not raise LDL cholesterol. That said, why eat only saturated fat? Eating a wide range of healthy fats from a variety of natural sources provides our bodies with all the essential fatty acids we can’t make, as well as provides us with foods that can reduce inflammation.

Beyond saturated fat that is found in the diet’s protein sources (meat, fish, egg, cheese and poultry), I recommend that people look mainly to mono-unsaturated plant-based fats such as those found in avocado, olive,  and avocado oil along with saturated fat and medium chain triglycerides from coconut oil (processed through the lymphatic system rather than the liver), modest amounts of  omega 6 fats from nuts and seeds, as well as plenty of omega 3 fats found in fatty fish.

It’s important to note that nuts and seeds such as almonds, walnuts, pumpkin and sunflower seeds, pistachios are a source of carbs (ranging from ~1.5–4 grams net carbs per ounce (30g)), so it’s important to use these in moderation, such as a few as a topping for a salad. In addition, nuts are high in omega-6 fats which are pro-inflammatory as they compete for binding-sites with omega-3 fats such as those found in fish.

Chia and flax seed are approximately 1–2 grams net carbs per 2 Tbsp (50 ml) and are excellent sources of both soluble and insoluble fiber.

All fats on the meal plan are healthy – which is why I call this approach “low carb high healthy fat”, but for a small percentage of people for whom high LDL cholesterol continues to be a concern, eating less saturated fat may be beneficial. Each person’s needs and familial risks are different, so no one low carb high healthy fat Meal Plan is the same.

Carbohydrate

Carbs are a healthy part of the low carb high fat diet, but the quantity of carb is minimized.

There are naturally-occurring carbs in non-starchy vegetables and low-sugar fruit (such as lemon, lime, eggplant, cucumber and tomatoes) as well as berries, as well as those found in nuts and seeds, as mentioned above.

Some versions of a low carb diet do not include nuts, seeds or berries during weight loss.

When starting a Low Carb High Healthy Fat Diet

Although not everyone does, some people experience some of the following symptoms, which usually subside within a couple of weeks. For each, I have offered some suggestions to minimize them:

  • headaches: often a result of eating too little salt. As insulin levels fall, so sodium is excreted by the kidney in urine. The drop in sodium results in the headache.  Taking 1-3 gms of salt per day (I prefer sea salt) will alleviate this. If you are taking medication for high blood pressure, be sure to check with your doctor before making any changes to your diet.  “Bone broth” is another way to restore electrolytes that are lost as insulin levels fall. Be sure you’re drinking plenty of water and also consuming enough salt/sodium.
  • sleep disruption: often a result of needing to urinate more, but sometimes experienced when people of switching from being in “carb-burning mode” to being in “fat burning mode”. Some people find taking some magnesium (with calcium) before bed helpful.
  • digestive changes: some people find they get slightly looser stools or get slightly more constipated when starting.  I can help troubleshoot this with you to get things back on track.
  • aches and pains: some people feel a little achy and almost flu-like for a few days when they are switching fuel sources.  Some people call this the “keto-flu”.  Making sure to have a balanced amount of sodium/potassium and calcium/magnesium as well as taking extra omega 3 fatty acids is helpful.

My role as a Dietitian

As a Dietitian, I make sure that you understand the effect that following a low carb high healthy fat diet can have on your body.  If you are taking medication for high blood pressure  (hypertension) or to lower blood sugar, I’ll ask you check with your doctor before starting, as blood sugar and blood pressure medications may need to be adjusted lower, as insulin levels fall.

If you aren’t taking any medication, I’ll help you transition into understanding that fat in and by itself is not ‘bad’ and that eating good quality healthy fats, nutrient-dense carbohydrate-containing foods and high quality animal protein is part of a healthy diet that will enable you to feel better, lose weight and lower insulin resistance.

I’ll design your Meal Plan so that it is adequate in macronutrients (protein, carbohydrate and fat) as well as micronutrients (vitamins and minerals – especially Calcium, Magnesium, Potassium, B-Vitamins, Vitamin A, Vitamin D, Vitamin K and Vitamin C) and sufficient in soluble and insoluble fiber  – suitable for your age, gender and activity level, and that factor in any diagnosed medical conditions you may have.

I’ll make sure that you are eating sufficient food in each of the food categories to meet your dietary needs, while adjusting for weight loss, if that is also a goal – so that you can just focus on eating healthy, ‘real food’.

Have questions? Feel free to send me a note using the form on the Contact Me tab, above.

To your health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

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The “Skinny” on Fats

INTRODUCTION:

Many people believe that saturated fat is “bad” for you but few people realize that our bodies actually manufacture it.  It’s true. In this article, I cover “just enough” chemistry (made very easy!!) for you to be able to understand the latest new findings. My next article will be on a change in the dietary recommendations of a key stakeholder in heart health in Canada, and what this change means.

If Saturated Fat was so Dangerous, Why Would our Body Actually Make it?

There are two sources of fats (also called “lipids“); those we eat in our diets and those our body makes. The fats we eat are called “exogenous fats” (“exo” meaning ‘from outside’) and the type of fats that our body makes are called “endogenous fats” (“endo” meaning ‘from within’).

Exogenous Fats

The types of fat that our body takes in as exogenous lipids from what we eat include saturated fats, and different kinds of unsaturated fats — including polyunsaturated fats — both omega 3 and omega 6, as well as monounsaturated fats. You can look back to the preceding blog, if you aren’t clear on these.

Endogenous Fats

Our body actually makes fat in a process called lipogenesis. This is important because some of the LDL cholesterol and triglycerides (TG) that gets reported on blood test results is endogenous; that is, our bodies made it. So we have high LDL (“bad” cholesterol) or triglycerides it’s not all from the fat we eat!

[Not only do our bodies make saturated fat, but excess carbohydrates gets stored in our body first as triglyceride and then if it still isnt needed, it gets stored as LDL cholesterol in our liver.  So carbs can raise both triglycerides and LDL cholesterol.]

Below, I will present just enough chemistry to understand the different types of fat and more importantly, be able to read about them and understand.

The Saturated Fat Our Body Makes and What it is Used For

1. The first thing that you need to know is that palmitic acid is a long-chain saturated fat is made (synthesized) in the liver. Palmitic acid is a 16-carbon fatty acid and having so many carbons in its backbone, it is considered “long chain”). It has no double bonds, so all the carbons in the backbone have a hydrogen bound to it (more on that below), so palmitic acid is a saturated fat.  Palmitic acid is found naturally in foods such as butter, cheese, milk and meat — but it is also synthesized by our bodies!

Now the message of the media since the mid- to late-1970s is to eat low-fat dairy; including low fat milk, low-fat yogourt and low-fat cheese with the assumption that saturated fat is “bad” for us — but our bodies actually manufacture it!


2. The other thing that you need to know is that a triglyceride is made up of three fatty acids attached to a glycerol molecule. That’s easy to remember, because “tri” means “3”.

a) Glycerol acts as the support for the other fats and is made up of three carbon atoms, each with something called a “hydroxyl group” bound to it.

A hydroxyl group (written “-OH”) is an oxygen and a hydrogen molecule bound together.  That is, water (H2O) is just a hydrogen (H) molecule bound to a hydroxyl (-OH) group.

So, this is a glycerol molecule;

As you can see, each of the carbons in the chain have a hydroxyl (-OH) group bound to it. Easy, so far, right?

b) Fatty acids are long chains of carbon atoms (i.e. think of a freight train, where each rail car is a carbon atom) with a carboxylic acid (-COOH) group at one end (i.e. the caboose is a carboxylic group). At each of the carbons in the chain, there is the potential for a hydrogen atom (H) to bind there.

You may recall from our previous article that a saturated fat is one that has no double bonds in the carbon chain, so in that case, all the carbon atoms in the chain have a hydrogen attached.  It is having all the carbons “saturated” with hydrogen atoms, that make it a “saturated” fat!

The names given to fatty acids are based on the number of carbon atoms and the number of carbon-carbon double bonds in the chain.


Different Kinds of Oils 

Remember, a triglyceride is made up of three fatty acids attached to a glycerol molecule. So, for example, palmitic acid and stearic acid are both exactly the same, except one has 16 carbons (palmitic acid) and the other has 18 carbons (stearic acid) in its chain.

Palmitic acid, a saturated fat has 16 carbons.  That is, it is “saturated” with hydrogen atoms at each of its 16 carbons. It is all of this “saturation” that makes saturated fat solid at room temperature.

Stearic Acid, is also a saturated fat, but has 18 carbons, so each of its carbons has a hydrogen bound to it,

Using just these two saturated fatty acids (palmitic acid and stearic acid) we can combine them in different ratios to make entirely different oils! For example, canola oil has a 4:2 ratio of palmitic acid to stearic acid and grapeseed oil has an 8:4 ratio of palmitic acid to stearic acid.

Furthermore, the same two fatty acids can be put together in the same ratio and be different fats. For example in a 7:2 ratio, it could be either almond oil or safflower oil — depending on how they are put together.

Palmitic acid, the saturated fat that our body makes is found in all kinds of “healthy” foods.

Lipogenesis – Our Bodies Making fat!

Lipogenesis is the process by which our bodies actually make fat and our bodies can make unsaturated fats or saturated fats.  

Unsaturated fatty acid lipogenesis

Our body can make a longer chain unsaturated fat from a shorter chain fatty acid (such as taking the linolenic acid from flax seed and adding carbons to the chain to make arachidonic acid). But there are limits.  Our bodies cannot take the linolenic acid from flax seed and make it into eicohexanoic acid or decahexanoic acid which are the healthy “omega 3 fats” fats found in  fish. So eating eggs made from chickens fed flax is not the same as eating fish.  We just can’t turn one into the other. Our body can make it longer, but not much longer.

Saturated fatty acid lipogenesis

As said above, our bodies synthesize palmitic acid, a 16 carbon saturated fat in our liver and then forms a triglyceride from three palmitic acid molecules attached to a glycerol molecule. These triglycerides are then transported around the body in something called a VLDL. More on that just below. 


Cholesterol – The Good the Bad and the Ugly

Most people know that HDL cholesterol is the so-called “good cholesterol” and LDL cholesterol is the “bad” cholesterol  — but where does LDL (“bad cholesterol”) come from? The first step when our body makes something called VLDL.

Very Low Density Lipoproteins (VLDL)

The body takes the triglycerides it manufactures in lipogenesis as well as takes in in the diet into Very-low-density lipoprotein (VLDL) cholesterol. These VLDLs move cholesterol, triglycerides and other lipids (fats) around the body.

VLDL is produced in the liver and include the triglycerides made with differing amounts of palmitic acid.  That is, our bodies MAKE palmitic acid in the liver and then combine the palmitic acid it makes in differing ratios, into triglycerides. It then takes the triglycerides, containing palmitic acid and protein and packages it into VLDLs. It then releases the VLDLs into the bloodstream, to supply body tissues with triglycerides.  About half of a VLDL cholesterol is made up of triglycerides, including those containing the palmitic acid it made!

High levels of VLDL cholesterol have been associated with the development of plaque deposits on artery walls, which narrow the passage and restrict blood flow.

VLDL cholesterol on blood test results aren’t measured, but estimated as a percentage of the triglyceride value.

What is LDL cholesterol?

When VLDL cholesterol reach fat cells (called “adipose tissue”), the triglyceride is stripped out and absorbed into fat cells. That means that VLDLs shrink.

Once a VLDL has lost a large amount of triglyceride it becomes a new, smaller, lipoprotein, which is called Low Density Lipoprotein, or LDL — the so-called ‘bad cholesterol’. LDL contains mostly cholesterol and some protein. Some LDLs are removed from the circulation by cells around the body that need the cholesterol contained in them and the rest is taken out of the circulation by the liver.

Here is the key point: the only source of LDL is VLDL. 

Saturated Fat — not dangerous and can be beneficial 

The media keeps telling us that “saturated fat is bad” and that it is even “dangerous” — but if it was so dangerous, why would our bodies actually manufacture it?  Our bodies manufacture palmitic acid, a saturated fat, then synthesize triglycerides from it which it sends all around our bodies, supplying our bodies with saturated fat!

Furthermore, there are some saturated fatty acids, called Medium Chain Triglycerides (MCTs) that are metabolized entirely differently than the longer chain saturated fatty acids and have beneficial properties.  These MCT oils go straight to the liver by the portal circulation and don’t need to be digested.

People who consume fats high in MCT oil, such as coconut oil which is almost half (44-55%) Lauric acid, an MCT have been found to have lower amounts of “belly fat” than those that do not consume these saturated fats.  Studies have found lower rates of “visceral adiposity” or “belly fat” in those that consume these fats, and correspondingly , lower lowering waist circumference.

Since carrying fat around the abdomen (the so-called “apple shaped” people) is considered to be a risk-factor to heart disease and studies have found that those who eat a diet high in MCT saturated fats have less fat around their middles and a smaller waist circumference, can we categorically say that saturated fat is really “bad” or “dangerous” to heart health. In fact, in our next article, we will outline the beginning of a change in the recommendations concerning saturated fat consumption.

Some thoughts…

Saturated fat and its consumption needs to be put into context; one context would be looking at the risks of a high carbohydrate diet compared with a high saturated fat diet, for example.  As covered in previous blogs, prior to 1977, when the dietary recommendations in Canada and the US changed to favour a diet low in saturated fat and high in carbohydrates, the rate of Diabetes was 1/10th what it is now and obesity rates in adults, especially men were too. Childhood obesity was almost unheard of prior to 1977.

Another context would be to differentiate between saturate fats.  That is, to look at which saturated fats.  Numerous studies demonstrate the benefits of MCT oils in increasing metabolism, lowering body fat, especially “visceral adiposity”.

Another context would be to determine how much of the “high cholesterol” (i.e. high LDL cholesterol) came from VLDL that was endogenously produced, versus eaten (exogenous).

Many studies have found that people are less hungry (have increased “satiety”) when they consume higher fat dairy products (which are rich in saturated fat), and as a result consume less calories overall than those that do not eat higher fat dairy products. So, we need to know which fats, and in particular which saturated fats are associated with this increased satiety?

It is my opinion that “vilifying” fat — labelling it as ‘unhealthy’ and the current government dietary recommendations and the media ads encouraging us to eat “low fat” everything, is creating a much bigger problem than the fat itself.  When manufacturers take out fat, they have to ‘replace” it with something and that ‘something’ is often sugar (simple carbohydrates).  Is increasing the carbohydrate content ‘safer’ than the naturally occurring fat that was found in the milk or yogourt or cheese, in the first place?

Recent studies seem to indicate that saturated fat consumption is not the issue when it comes to heart risk — and that saturated fat may actually be protective against heart risk. Certainly there are many studies showing the benefits of consuming MCT oil for reducing “belly fat”, which reduces heart risk — so can we say that something like coconut oil, used in moderation is “bad” or “dangerous”.

Looking at the epidemiological data from the last 35 years, we can see what has happened to obesity rates and diabetes rates since both the American and Canadian governments have been encouraging us to eat “low fat” everything.

Are naturally occurring fats really the issue — or are synthetic “trans fats” and excess carbohydrate?

At this point in time, I am persuaded by the many studies I have read, that naturally occurring fats, including saturated fat are not “bad” or “dangerous” when consumed as part of a whole-foods diet.

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2016 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.


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Carbs or Fat – which one should we eat less of?

lipids-and-fats-11-638

Intro: Since 1977, Health Canada and Canada’s Food Guide have been promoting a diet which is high in carbs (45-65%) and low in fat (20-35% ) and which recommends that no more than 7% of fat comes from saturated fat — with the goal of lowering heart disease.

As elaborated on in an earlier blog, prior to 1977, the obesity rate [measured as Body Mass Index (BMI) ≥ 30 kg / m2] of Canadian adults was <10% and in 1978, only 15% of children and adolescents were overweight or obese.

As a result of lowering dietary intake from fat and increasing it substantially from carbohydrates, what happened to obesity statistics? Diabetes statistics?

Obesity became an epidemic.

In adults the prevalence of obesity [body mass index (BMI) ≥30 kg/m2] went from 10% in 1970-72 to 26% in 2009-11! In children, that rate doubled to 29% of children and adolescents being overweight or obese by 2007 and by 2011, obesity prevalence for boys was 15.1% and for girls was  8.0% in 5 to 17 year olds.

Based on waist circumference, 37% of adults and 13% of youth are currently considered abdominally obese.

Diabetes rates almost doubled.

In the 1970s, the rate of Type 2 Diabetes in women was 2.6% and 3.4 % in men, in the 1980s that number rose to 3.8% for women and 4.5% for men.  In the 1990s the rate was almost double what it was in 1970; 4.7% for women and 7.5% for men.

Now get this: Type 2 Diabetes contributes to increased risk of heart disease.

So in an effort to reduce rates of heart disease by lowering fat intake and increasing carbohydrate intake, rates of Type 2 Diabetes doubled — which in turn, raised the risk of heart disease! Ironic.

If eating a high carbohydrate, low fat diet is associated with higher rates of obesity which in turn results in a higher incidence of Type 2 Diabetes, what is the option? Isn’t it also a problem to eat a low carbohydrate / high fat diet… isn’t a high fat diet bad for you?”.

This is the question that we will begin to answer in this article and conclude in the next one.


Are all fats the same? Is extra virgin olive oil in the same category as bacon? Or fish oil as lard?

The Health Canada guidelines recommend eating low fat dairy products, lean meat and using a “small amount — 2 to 3 tablespoons (30 to 45 mL ) of unsaturated fat each day. This includes oil used for cooking, salad dressings, margarine and mayonnaise“.

1. We are told to use a small amount of unsaturated fat per day; what is an unsaturated fat and are they all the same?

2. Is the fat in dairy products and meat “bad” for you?

I am going to answer the first question in this article and the second question in the next one.


1. What are the different type of fats.

There are two main classes of fats — saturated fats and unsaturated fats.

Unsaturated fat can be further classified as polyunsaturated fats and mono-unsaturated fats. Polyunsaturated fats include everything from omega-3 fats from fish oil to the fat found in omega-6 fats found in canola oil and corn oil. More about what makes it an ‘omega-3’ or ‘omega-g’ below. Omega-3 fats, especially the long chain ones from fish oil (e.g. DHA, EPA) are heart-healthy and are anti-inflammatory and have been found to be protective against heart disease. Refined seed oils that are high in omega-6 fats are pro-inflammatory.

Monounsaturated fats such as those found in avocado and nuts or cold-expressed from olive oil or avocado or nuts and seeds are considered by Health Canada and the writers of Canada’s Food Guide as the healthiest (and thus, preferred) kind of fat.

We’ve been told to eat a “low fat diet” but are all fats the same? Are omega-3 fats from fish to be lumped together with fat from bacon? And if we eat a diet low in saturated fat, will our “bad” cholesterol (LDL) go down?

Most people have heard that of the fats taken in from the diet, saturated fat is “bad” for you and mono-unsaturated fat and polyunsaturated fat is “good” for you.  Before we deal with whether this is true, let’s define what these are.

There are some basics that we need to cover, to ‘follow’ the discussion as to whether saturated fat in the diet results in high LDL cholesterol and high Triglycerides (TG). I’ll try to make this much less painful than it may have been when you first learned this.

  • fatty acids are molecules made up of a carbon backbone.  Think of it like a train with cars connected together.  Actually think of it more like “fuselage” of a plane (which will become clear as to why, below). The body is made up of carbons all in a row.
  • if there are no double bonds in the carbon chain, it is a saturated fatty acids because something can bond at every carbon along the carbon chain.  Think of those molecules that bond to a carbon as “wings” sticking off the fuselage.
  • if there is one double bond in the carbon chain, it is an unsaturated fatty acid. It is “unsaturated” because no other compound can bond where the double bond is. So it can have “wings” every where else along the carbon chain (which makes it unsaturated) but not at the place where the one double bond is.
  • if the carbon chain has more than one double bond, it is called a polyunsaturated  fatty acids (PUFAs).
  • there can be a double bonds off one of the carbons in the carbon backbone chain.
  • where the double bond off the carbon backbone is located determines whether it is an omega-3 polyunsaturated fatty acid or an omega-6 polyunsaturated fatty acid.
  • all omega-3 fats have their first double bond in the same place on the carbon chain (away from what is called the ‘carboxyl’ end).  All omega-3 fats have their first double bond starting at the 3rd carbon (away from what is called the ‘carboxyl end’).
  • all omega 6 fats have their first double bond starting at the 6th carbon (away from the carboxyl end)

That’s pretty well all the chemistry you need to know.

So we’ve heard that we should decrease our intake of all fat, especially saturated fat as it leads to high LDL cholesterol, high triglycerides (TG) but is that true?   2. Is the fat in dairy products and meat “bad” for you?

3. Is saturated fat in the diet the only source?

Spoiler alert!

Our bodies not only make fat, they synthesize saturated fat!

We will cover the making of endogenous (“in the body”) saturated fat in Part 2, coming soon!

Have questions about the services I offer? Please click on the “Contact Us” tab above, to send me a note.

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2015 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.


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Weight Gain as a Hormone Imbalance not a Calorie Imbalance

scaleWeight gain is not caused simply by taking in more calories than you burn (the so-called “calorie-in / calorie-out” model).  Calories in and calories out are interdependent factors, so when calories are restricted the body actually slows its metabolism, lowering the energy it uses for vital bodily functions. Basal Energy Expenditure (BEE) can decrease by as much as 30-50% in order to spare calories!

On the opposite end, when too many calories are taken in by someone who is already overweight, the body will try to get rid of them by increasing its Basal Energy Expenditure, usually by speeding up respiration, increasing heart rate and breathing and generating more heat.

The body does this because its ‘set point’; the weight at which your body likes to be and will tend to stay with very little effort, is highly regulated. It really isn’t that easy to gain or lose weight if we haven’t already compromised this built-in homeostatic mechanism.

That is why trying to control calories doesn’t work for long term weight loss. When we restrict calories, and increase our exercise, our body responds by increasing hunger, initiating craving (especially for foods such as simple carbs that can be broken down quickly to glucose for your blood) and by decreasing the amount of energy it uses.

Have you ever skipped a meal or lowered your calories so much that you feel cold; even though the room is at an adequate temperature and you are dressed appropriately? You are shivering because your body is sparing calories it would normally use for heat generation.

Body Weight is Regulated by Hormones

Body weight is not really under our control as much as we’d like to believe.  It is a tightly regulated process that involves a variety hormones including leptin (a hormone that regulates fat stores by inhibiting hunger), ghrelin (a hormone that increase hunger when your stomach is empty) and insulin, which plays a very significant role in hunger, eating behavior and fat management.

To understand how significant a role insulin plays in weight regulation, let’s look at a situation where there is insufficient insulin. Type I diabetes results from the destruction of the insulin-producing pancreatic islet cells stemming from an autoimmune disorder. One of the hallmarks of this disease and it’s very low levels of insulin is severe weight loss. Type I diabetics need to take insulin injections to correct for the insulin deficiency but the more insulin that is taken, the more weight gain there is. As insulin levels go up, hunger is triggered and we feel the urge to eat.

Insulin is one of the major controllers of the body set point.

As mentioned, if we don’t take in sufficient calories, then our body decreases our Basal Energy Expenditure so that we end up maintaining our body weight in response to whatever the number of calories are that we take in.  The issue in weight gain is not how to reduce calories but how to reduce insulin.

Insulin as the Main Factor in Weight Gain

When we eat food, our body releases insulin in response to the rise in glucose in our blood, coming from the digested food. Insulin acts as a messenger to instruct the body’s cells to absorb glucose, in effect reducing blood glucose levels.

Insulin resistance is a condition in which the cells of the body become resistant to insulin and fail to respond normally to normal levels insulin, leading to higher blood sugar. The pancreas tries to compensate to this condition by producing more and more insulin.  As long as the pancreas is able to produce enough insulin to overcome this resistance, blood glucose levels remain normal but when the pancreas can no longer produce enough insulin, the blood glucose levels begin to rise.

Initially, this added rise in blood glucose happens after meals (when glucose levels are already at their highest) and more insulin is needed – but eventually these higher levels of glucose are seen first thing in the morning when the person hasn’t eaten for 8 or 10 hours. When blood sugar rises abnormally above specific clinical levels, the person is diagnosed as having Type 2 diabetes. Insulin resistance is often called “pre-diabetes” because it precedes the development of Type 2 Diabetes.

Consistently high blood glucose levels along with insulin resistance lead to cells that are starved of glucose even though there is plenty of glucose in the blood. Since the cells aren’t getting any of the glucose even though it is there, it is not available to the cells because insulin is not binding it and taking it in. As a result, hunger signals are sent to the brain, leading to eating, even though the person has recently eaten.

As more and more glucose accumulates (both from the food being eaten and as you will see in a minute, through the making of glucose due to the effect of cortisol, another hormone) the high levels of glucose trigger the body to store the excess glucose as body fat.

The Effect of Stress on Weight Gain

Cortisol, the so-called stress hormone also plays a role in weight gain. Let’s look at another medical conditions to illustrate the effects of cortisol. In Cushing Syndrome, cortisol is over-produced by the body and weight gain results.  When we give people a synthetic form of cortisol as a medication (e.g. prednisone) they get something called Cushinoid Syndrome.  That is, they look like they have Cushing ’s disease. Not only do they gain weight, but there is a particular distribution of this weight gain called truncal obesity which means that fat is gained around the belly, rather than on the arms and legs.

In adrenal insufficiency (also known as Addison’s disease) which produces the opposite effect, the adrenal gland becomes damaged due an autoimmune condition and is unable to produce cortisol.  The hallmark of Addison’s disease is weight loss.

So what role does cortisol play in healthy individuals? Cortisol is released as a result of ordinary events such as waking up in the morning or exercising, but also is released in response to physiological and psychological stress.  Physiological stress might be an illness or injury and the release of cortisol services a needed function to make sure we have enough glucose to heal.

Under stressful conditions, cortisol also plays the role of providing the body with glucose by tapping into protein stores via gluconeogenesis in the liver. This energy can be helpful in a “fight or flight” type of stressor, such as when one is being chased by something however under constant levels of psychological stress, elevated cortisol over leads to higher levels of glucose being made from protein in the body the long term.  So in addition to glucose coming from the food we eat (exogenous sources), we now have the body making its own glucose (endogenous sources).  The combined exogenous glucose from good and the endogenous glucose triggered by cortisol, now leads to even higher blood sugar levels that without the long term stress.

With continually high levels of cortisol, the body will take fat that is stored as triglycerides in our liver and relocate them to visceral fat cells — those under the muscle, deep in the abdomen. Just like in Cushing’s syndrome, we now see truncal obesity triggered by stress, mediated by cortisol.

Weight Gain is due to Hormonal Triggers and not a Lack of Will-Power

Cortisol also directly influences appetite and cravings by binding to hypothalamus receptors in the brain, triggering us to eat and crave foods that are easily broken down to glucose.  Cortisol also indirectly influences appetite by modulating other hormones that stimulate appetite. Simple carbohydrates like bread, pasta, candy and pop are common foods that people reach for in response to these craving because they are easily broken down to simple sugars. So, it is actually the higher levels of cortisol that lead to increased appetite and in particular cravings for high-calorie foods, not simply a lack of will-power.

As you can see, we don’t really control our body weight any more than we control our heart rates.  To a large degree, body weight is regulated automatically under the influence of hormones; hormones that indicate to eat and indicate when we are satiated.  Hormones signal our bodies to increase energy expenditure and when calories are restricted, hormones will slow energy expenditure.

Why All Diets Work and often All Diets Fail

It doesn’t really matter which diet people follow, whether it is Atkins, South Beach, or the good old fashioned low fat, low calorie diet, all diets in the short term produce weight loss. Yes, some are healthier than others, but they all “work”.

One would hope that by continuing to eat according to what ever diet we’ve chosen and by exercising, that our body’s set point would reset at a lower level, but this doesn’t happen.

Insulin levels stay high, continuing to drive hunger and eating.

How does this affect weight loss?

A few months into our diet, regardless what diet we follow, weight loss begins to plateau.  As the plateau continues, people get discouraged, and think to themselves ‘if I’m not losing weight, then I may as well eat – fill in the blank’. This is either followed by an abandoning of the diet completely and a regaining of the weight previously lost (or more) or by a stubborn insistence to restrict calories and fat even further — leading to a downshifting of basal energy expenditure. It’s a vicious cycle.

But why does Body Weight Plateau in the First Place?

In response to weight loss, the body tries to return to its original set point.  First it slows metabolism to try and slow down weight loss – resulting in slowed weight loss and eventual plateauing.

The reason is because we’ve done nothing to lower insulin levels.

Think of set point like a ‘body weight thermostat’. With a thermostat, when the air is hot enough, the furnace turns off and when it is too cool, the thermostat turns the furnace on.  Regardless what kind of diet a person follows, there will be weight loss effects in the short term, but eventually, even with continued compliance, body weight plateaus and in time, the person begins to regain the weight.

What about exercise?

Surely exercise will help us lose weight, right?

Basal energy expenditure which is the amount of energy we use at rest is estimated to be approximately 12-15 calories per pound.  For someone confined to complete bed-rest, caloric needs are calculated as 1.2 times Basal energy expenditure (BEE).

To visualize the effect exercise has on calorie loss, let’s take a 140 pound person as an example, whose basal caloric needs are 2200 – 2500 calories per day. Say they start exercising.  They start walking at a moderate pace (2 miles/hour) for 45 minutes every day, and burn roughly 104 calories.  Let’s look at that in terms of basal energy expenditure – that is only 4% of the BEE.  Okay, so say the person starts working out at a more vigorous pace, calorie burning will go up, right?  But how much?  6% of BEE?  8% of BEE? That’s about it.

The bottom line is, the vast majority of calories you take it; about 95% of caloric intake is used to heat the body and other metabolic processes, including keeping your heart beating, breathing, digestion, brain function, liver and kidney function, etc.

Set point is a tightly regulated mechanism, like a thermostat.  When we burn more calories through exercise two things happen.  Studies show that people actually end up decreasing their activity outside of the period of exercise and the other is they increase their caloric intake in response to exercise. That’s where the phrase “working up an appetite” comes from.

The reason exercise is not that effective for weight loss is because of metabolic compensation.  We understand this intuitively though, don’t we? When know when we cut calories, restrict certain foods and increase our exercise that our body responds by being more hungry and increasing cravings. We try to take extreme measures only to find that we don’t really have a chance at making the weight loss last long term.

Don’t misunderstand; exercise is good for you.  There are many benefits to regular exercise such as improved cardiovascular function, increased strength and flexibility, and lowering stress which will lower cortisol but weight loss is not one of the significant benefits of exercise.

So if restricting calories causes are energy usage to slow and results in us being more sedentary outside of the times we exercise or eating more in response to exercise, how do we lose weight and keep it off?

To keep weight off long term, we need to address the underlying hormonal trigger to hunger and appetite; mainly insulin. To lower weight and keep it off, we need to lower our insulin level.

There are two aspects to lowering insulin levels (1) the foods we eat and (2) when we eat and this will be the topic of the next blog.

scale

 

 

 

 

 

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2015 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Feel free to share!

Obesity Rates in Canada and Changes to Canada’s Food Guide

Introduction: Many people look to Canada’s Food Guide (CFG) as the “measuring stick” as to whether they are eating a healthy diet, but did you know that over the years, CFG has changed dramatically? Canada’s first food guide, the Official Food Rules, was introduced to the public in July 1942. This guide acknowledged wartime food rationing, while endeavoring to prevent nutritional deficiencies and to improve the health of Canadians. Over the years the names of the food groups, the serving sizes and numbers of servings has changed.  Serving sizes are now given in ranges; and one has to wonder if these changes have resulted in “over-nutrition”.

Changes in Canada’s obesity rates seems to parallel the changes in Canada’s Food Guide which is the topic of this blog.


Canada’s Food Rules – 1949

The post-WWII “Canada’s Food Rules” of 1949 emphasized people taking in sufficient nutrients to prevent nutritional deficiency as well as to avoid excess, by stressing that “more is not necessarily better”.

Adult guidelines promoted;

canadas_food_rules_19492 cups or more of full fat milk

1 serving of citrus or tomatoes daily & 1 other fruit

2 serving potatoes plus 2 servings other vegetables (preferably yellow or green and frequently raw)

4 slices of bread with butter and 1 serving whole grain cereal

one serving meat, fish or poultry or dried beans, eggs (3x / week), cheese (3x / week)

use liver frequently


Canada’s Food Guide – 1961

In the 1961 version the language softened; with “Guide” replacing “Rules” in the title. Canada’s Food Guide now sought to emphasize its flexibility and wide-ranging application for healthy eating, recognizing that many different dietary patterns could satisfy nutrient needs.

Adult guidelines promoted;

1961-eng1 1/2 cups or more of full fat milk (decreased by ½ cup)

1 serving of citrus or tomatoes daily & 1 other fruit

2 serving potatoes plus 2 servings other vegetables (preferably yellow or green and frequently raw)

4 slices of bread with butter and 1 serving whole grain cereal

one serving meat, fish or poultry, eggs (3x / week), cheese (3x / week) or dried beans

use liver frequently

Reference: Nutrition Division, National Department of Health and Welfare (1961). Rules out – guide in. Canadian Nutrition Notes, 17(7):49-50 (cited in Health and Welfare Canada. Action towards healthy eating: technical report. 1990).


Canada’s Food Guide – 1977

In 1977 Canada’s Food Guide underwent a dramatic revision. There were now four food groups, instead of five, as fruits and vegetables were combined since their nutrient content overlapped and the name of those groups changed, too.

The Milk group became Milk and Milk Products, to highlight the inclusion of other dairy foods, Meat and Alternates replaced Meat and Fish allowing for vegetarian choices — but also resulting in the inclusion of things like peanut butter in this category, rather than categorized in the ‘fat’ category as occurs in other systems, such as the Food Exchanges.

Most significantly, serving ranges were added.

The big focus was on more carbs and less fats (regardless of what the sources of those fats were) — there was no differentiation between lard and olive oil. There was a shift to using low fat dairy products and the beginning of generations of “fat phobic” Canadians began.  “Low Fat” products became all the rage.

cfg_history_1977_two_small2 servings (skim, 2%, whole) milk, buttermilk or yogourt (1 serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

4-5 servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

3-5 servings of Bread and Cereal

2 servings  Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or 1 cup dried cooked legumes or ½ – 1 cup* nuts or seeds).

In 1977, there was introduction of a concept of “energy balance”; balancing energy intake with energy output (“calories in / calories out” model) which makes the assumption that basal metabolic rates stays the same.

With the goal of reducing diet-related chronic diseases (such as heart disease and high blood pressure), Canada’s Food Guide encouraged Canadians to reduce salt and fat, without distinguishing between sources of fats. In the process, the quantity of all kinds of fat, including healthy monounsaturated fats such as olive oil and nut and seed oil were all reduced.  Canada’s Food Guide encouraged Canadians to eat plenty of fruits and vegetables without distinguishing between high fiber, non-starchy vegetables and high carbohydrate starchy vegetables. More on that below.

Before 1977, the obesity rate [measured as Body Mass Index (BMI) ≥ 30 kg / m2] of Canadian adults was <10%.  Keep that number in mind. It changes considerably over the years as Canada’s Food Guide recommendations changed.


A report submitted to Health Canada in 1977 by the Committee on Diet and Cardiovascular Disease advised the government to take action to prevent diet-related chronic diseases such as heart disease and high blood pressure, so the emphasis in the revised 1982 Canada’s Food Guide was towards even lower fat products.

Lower fat in products often meant more sugar (as fructose or high fructose corn syrup) being added to products such as yogourt, to help make up for the missing taste. Portions of nuts and seeds which contain heart-healthy monounsaturated fats were reduced in the ongoing push to lower all fat in the diet.

There was a continued shift towards carbs as the main source of calories; not only from Breads & Cereals, but from Fruit & Vegetables too — and in this category, there was no distinction between starchy vegetables (such as potatoes, peas, corn, squash and yams) and non-starchy vegetables, such as salad greens or asparagus.  As a result, a serving of sweet potato was categorized no differently than a serving of salad greens.

Furthermore, a serving of fruit juice was considered equivalent to a serving of fruit; with no concern for the fact that there was no fiber in the juice and significantly more carbohydrates per serving.  Carbs were perceived as “good” and fat was promoted as “bad”.  As a result of these changes, under this new Canada’s Food Guide, one could have 3 glasses of juiceone serving of potato and a tiny salad and “meet” the guidelines.

Canada’s Food Guide – 1982

Adult guidelines promoted;

cfg_history_1982_two_small2 servings (skim, 2%, whole) milk, buttermilk or yogourt (1 serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

4-5 servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

3-5 servings of Bread and Cereal

2 servings  Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or 1 cup dried cooked legumes or ½ cup* nuts or seeds).

Reference: Ballantyne, R.M., Bush, M.B. (1980). An evaluation of Canada’s food guide and handbook. Nutrition Quarterly, 4(1):1-4.


Canada’s Food Guide – 1992

In 1992, Canada’s Food Guide became Canada’s Food Guide to Healthy Eating.

A new “total diet approach” aimed to meet both energy (calories) and nutrient requirements, resulted in large ranges in the number of servings in the four food groups.

To meet higher energy needs, the Guide encouraged selection of more servings from the Grain Products and Vegetables and Fruit groups – resulting in an even higher percentage of carbohydrates in the diet.

Adult guidelines servings changed as follows:

cfg_history_1992_two_small3-5   5-12 servings of Bread and Cereal

4-5   5-10 servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

2   2-4 servings (skim, 2%, whole) milk, buttermilk or yogourt (serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

2   2-3 servings Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or ½ – 1 cup cooked legumes or 2 Tbsp. peanut butter)

Grain Products were now 1st on list (5-12 servings!); reflecting the shift that most of calories (45-65% of calories) were to come from carbs.

Vegetables and Fruit were put 2nd on the list (5-10 servings) and could still be chosen as all carbs (potato, yams, other starchy vegetables, fruit, fruit juice) and along with this, there was a continued decrease in calories from fat (e.g. nut butters went from ½ cup – 1 cup in 1977 to ½ cup 1982 to 2 Tbsp. in 1992)

Also in this Guide, cheese was categorized with milk and yogourt – even though other ways of accounting for food such as the Diabetic Exchanges, classify cheese with Meat and Alternates (and nut butters with fat).


In 2005, there were even more changes to Canada’s Food Guide to Healthy Eating.  This is the Guide currently in use in Canada.

The numbers of servings were broken down based on stage of life and gender, but continuing the emphasis on high carbohydrate, low fat.  There were different number of servings per day for children aged 2-3, aged 4-8, aged 9-13, adolescent girls (aged 14-18), adolescent boys (aged 14-18), men (until aged 50), women (until aged 50) and then men over 50 and women over 50.

While Vegetables and Fruit were now put 1st instead of Grain Products, these could still be chosen as mostly carbs (potato, yams, other starchy vegetables, fruit, fruit juice), so with Grain Products put 2nd, carbs still formed the bulk of daily calories.


Canada’s Food Guide – 2005

Adult guidelines promoted (adults aged 19-50 years):

CFG 20055-10   7-8 (women) 8-10 (men) servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

5-12   6-7 (women) 8 (men) servings of Grain Products

2-4   2 (women and men) servings (skim, 2%, whole) milk, buttermilk or yogourt (serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

2-3 servings Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or ½ – 1 cup cooked legumes or 2 Tbsp. peanut butter)

Recommendations include:

Vegetables and Fruit

go for orange vegetables such as carrots, sweet potatoes* and winter squash*

*Note: starchy vegetables such as sweet potato and winter squash contain the SAME number of carbohydrates per serving as a serving of Breads and Cereals i.e. 15 g carbohydrate per ½ cup serving compared with non-starchy vegetables such as asparagus, broccoli and salad greens.

Under this Guide, Vegetables and Fruit can contribute 105 g – 150 g carbs per day (400 – 600 calories per day) if chosen as starchy vegetables and fruit / fruit juice.

Milk and Alternates

The Guide recommends: “Drink skim, 1% or 2% milk each day” which overlooks the satiety (feeling fuller) effect of higher fat dairy.

“select lower fat milk alternates” – fails to look a the fact that loads of sugar as flavouring replaces the fat, contributing the equivalent of 2 – 4 servings of carbs per 3/4 cup serving (where a serving of carbs as per the Food Exchanges is considered 15 g carbohydrate per serving)

Oils and Fats

The Guide recommends: “include a small amount (2-3 Tbsp.) of unsaturated fat each day.  This includes oil for cooking, salad dressing, margarine and mayonnaise. Use vegetable oils such as canola and soybean” resulting in the decrease of healthy-monounsaturated fats such as olive oil, nuts and seeds.

Children

The Guide recommends to “serve small nutritious meals and snacks daily

Three meals AND a few snacks?

What effect have these dietary recommendations had on obesity statistics?

Let’s look at children;

  • In 1978, only 15% of children and adolescents were overweight or obese.
  • By 2007, that rate doubled to 29% of children and adolescents being overweight or obese.
  • By 2011, obesity prevalence alone for boys was 15.1% and for girls was at 8.0% in 5 to 17 year olds.

What about adults?

  • The prevalence of obesity [body mass index (BMI) ≥30 kg/m2] in Canadian adults increased from 10% in 1970-72 to 26% in 2009-11
  • Based on waist circumference 37% of adults and 13% of youth are abdominally obese.
  • Looking at these numbers slightly differently, as of 2013, there were approximately 7 million obese adults and 600 000 obese school-aged children in Canada

One has to wonder whether this dramatic increase in obesity and overweight after 1977 is correlated to Canada’s Food Guide shift to lower fat, higher carbohydrate diets.

In my  Dietetic practice, I give clients a choice of meal plan patterns because I don’t believe three meals and three snacks per day with 45-65% of calories as carbohydrate is the best way for people to address the matter of their excess weight.

For clients that come to me insulin resistant and/or overweight, I explain based on the literature why I recommend a meal plan pattern based on full meals without snacks with most of the calories coming from heart healthy satiety-offering monounsaturated fats. When clients are able to eat until they are satisfied without feeling hungry between meals and without feeling deprived, they are able to lose weight naturally and relatively easily.

Of course if clients want a meal plan based on the traditional 3 meals and 3 snack meal pattern I provide that for them using current recommendations.  There is no question that both ways, people can lose weight and lower their blood sugars, but my interest as a Dietitian is not only to see people’s weight and blood sugar and cholesterol come down, but to also see them feeling good and being happy with the process.

If you would like more information on the services I offer, please click on the Contact Us tab, above to send me a note.

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2015 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

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Canada’s Food Guide – an Epidemiological Experiment Gone Terribly Wrong?

Health Canada released a statement this past Tuesday (May 19, 2015) implying they may change Canada’s Food Guide recommendations. Their statement came just a week after a Canadian Medical Association Journal released a report a week earlier (May 11, 2015) summarizing some of the criticisms of the Guide made by healthcare professionals who presented at the Canadian Obesity Summit in Toronto at the beginning of May.  One of the criticism included Health Canada’s current endorsement of 100% juice as equivalent to a serving of fruit.

Canada’s Food Guide (officially called Eating Well with Canada’s Food Guide) recommends that Canadian adults consume up to 10 servings of fruit and vegetables a day (depending on age and gender) and with a half-cup of juice counting as a single serving, it’s easy to see how a person might drink a few cups of fruit juice a day in order to try and meet that requirement.  The problem arises that even a single glass of orange juice can put you over the daily sugar limit recommended by the World Health Organization (WHO).

In March, the World Health Organization (WHO) released a report entitled Guideline: Sugars intake for adult and children where it concluded that the world was consuming too much sugar and recommended that people cut their intake of sugar to the equivalent of just six to 12 teaspoons per day.

Many popular brands of 100% orange and apple juice sold in Canada contain as much as five teaspoons of sugar per serving so it’s easy to see that if the public is trying to meet their 7-10 servings of fruit and vegetables by drinking juice, they will be way over the WHO’s daily sugar limit.

A study from the UK that was just published 2 weeks ago in the European journal Diabetologia linked daily consumption of sweetened drinks including so-called “healthy” beverages like sweetened milk and fruit juice with increased diabetes risk. The study found that for each 5% increase of a person’s total energy intake provided by sweet drinks (even so-called “healthy ones” like chocolate milk and 100% juice) that the risk of developing Type 2 diabetes could rise by 18 %. The study also found that by replacing one sweetened drink with water or unsweetened tea or coffee per day could help cut the risk of developing diabetes by as much as 25%.

This most recent statement from the director of the Office of Nutrition Policy and Promotion Hasan Hutchinson said the department is currently “reviewing the evidence base for its current guidance” to Canadians and that “depending on the conclusions of the scientific review, guidance for consumption (quantity and frequency) of various foods, including juice, could be updated in the future”. In my opinion, consumption of 100% fruit juice as equivalent to a serving of Vegetables and Fruit is not the only aspect of Canada’s Food Guide that Health Canada needs to re-evaluate.

Shift to a Carbohydrate-based Diet; how has that worked out?

Prior to 1977, Canada’s Food Guide recommended no more than 5 servings of bread or cereal per day for adults and now recommends 6-7 servings per day of Grain Products for women and up to 8 servings of Grain Products per day for men. In 1961, Canada’s Food Guide recommended only 1 serving of citrus fruit (as fruit) or a serving of tomatoes daily & only one other fruit.  Now adults can have any of the recommended 7-10 servings of Vegetables and Fruit per day as fruit (or juice). Even as actual servings of fruit, current recommendations can be chosen as 4-5 times the amount of fruit as in in 1961.

Since 1977 and in ever increasing amounts, Health Canada has shifted their recommendations away from healthy fats and low carbohydrate diets, towards diets where carbohydrates form the main source of calories.  Current recommendations are for 45-65% of calories to come from carbohydrate and only 20- 30% of calories from fat.  Our society has become “fat phobic” thinking all sources of fat are “bad”. People drink skim or 1% milk and eat 0% yogourt and low fat cheese; all the while making sure to have “enough’ carbohydrates; 6-8 servings of Grains Products (including bread, pasta and rice). Hidden as Vegetables are even more carbohydrates as the 7-10 servings of Vegetables and Fruit which are recommended for an adult to eat makes no distinction between starchy vegetables (like potatoes, yams, peas and corn) and non-starchy vegetables (like salad greens and asparagus or broccoli). People can literally eat all their Vegetable and Fruit servings as carbohydrate laden starchy vegetables and fruit and “meet” Canada’s Food Guide!

Canadians are encouraged to fill themselves up on toast or cereal for breakfast, sandwiches or rice for lunch and pasta or pizza (with “healthy toppings”) for supper; all in an effort to “meet” Canada’s Food Guide.

At the same time, people have been conditioned to avoid fats because they believe that fat is “bad”; while making no distinction between healthy fats from avocado, nuts, seeds and fatty fish and fats from chemically cured bacon and nitrite- laden sausage.

What Has Happened to Canada’s Obesity Rates since 1977?

In ever increasing amounts, Health Canada has recommended that we avoid fat and get 1/2 to 2/3 of our calories from carbohydrates? How has Canada’s obesity rate changed since then?

In 1978, only 15% of children and adolescents were overweight or obese.

By 2007, 29% of children and adolescents were overweight or obese.

By 2011, just the obesity prevalence for boys was 15.1% and for girls was 8.0% in 5- to 17 year olds.

What about adults?

The prevalence of obesity [body mass index (BMI) ≥30 kg/m2] in Canadian adults increased two and a half times; from 10% in 1970-72 to 26% in 2009-11.

In 1970-72 7.6% of men and 11.7% of women were considered obese.

In 2013, 20.1% of men and 17.4% of women were considered obese.

And looking at waist circumference rather than BMI, 37% of adults and 13% of youth are currently considered abdominally obese.

So how has Health Canada’s recommendations of a high carbohydrate low fat diet been working out?

Certainly there must be a better way?

There is.

More in my next blog.

In the meantime, if you would like to learn a better way to think about food why not contact me?

I can help you begin to tackle overweight or obesity in a way that encourages eating healthy fat and which are supported by current research literature.

I can also help you learn which sources of carbohydrate provide the best nutrition to meet your daily recommended nutrient intake for vitamins and minerals as well as how to eat in a way that can begin to tackle one of the main issues associated with being overweight; that of insulin resistance.

Click on the “Contact Us” tab above, to send me a note.


References

Canadian Medical Association Journal, Early Releases (May 11, 2015), Food Guide Under Fire at Obesity Summit, www.cmaj.ca/site/earlyreleases/11may15_food-guide-under-fire-at-obesity-summit.xhtml

http://www.cbc.ca/news/health/canada-food-guide-s-listing-of-juice-as-a-fruit-serving-called-bananas-1.3080658

http://www.ctvnews.ca/health/will-fruit-juice-be-cut-from-canada-s-food-guide-1.2380960

Janssen I, The Public Health Burden of Obesity in Canada, Canadian Journal of Diabetes, 37 (2013), pg. 90-96

Nutrition Division, National Department of Health and Welfare (1961). Rules out – guide in. Canadian Nutrition Notes, 17(7):49-50 (cited in Health and Welfare Canada. Action towards healthy eating: technical report. 1990).

O’Connor, L, Imamura F, Lentjes M et al, Prospective associations and population impact of sweet beverage intake and type 2 diabetes, and effects of substitutions with alternative beverages, Diabetologia May 6, 2015 [Epub ahead of print]

Statistics Canada, Overweight and obese adults (self-reported) 2009, http://www.statcan.gc.ca/pub/82-625-x/2010002/article/11255-eng.htm

World Health Organization, Guideline: Sugars intake for adult and children, March 2015, http://who.int/nutrition/publications/guidelines/sugars_intake/en/

Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2015 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Feel free to share!

Why do we Gain Weight – the Myth of “Calories in, Calories out”

People often assume that the answer to the question why do we gain weight is obvious and it is because people eat more calories than they burn; the old “calorie in, calorie out” paradigm.  That is, calories not used in some form of exercise are converted to fat and stored.  If we assume that the cause of weight gain is that simple, then the solution must be equally simple; eat less and exercise more, right? But is it?

Many Physicians and Dietitians continue to hold to this “calorie in, calorie out” model and to counsel their patients that in order to lose the stored fat, they need to eat less and exercise more.  If it is really that simple, then why are 4.7 million adults in Canada classified as obese and more than 40% of men and 27% of women classified as overweight? If it is that simple, why do obesity statistics continuing to rise? Because it isn’t that simple.

There is an underlying assumption that “calories in” and “calories out” are two independent events.  That is, if you reduce “calories in”, “calories out” is unaffected. The difficulty lies in that the body decides where it is going to “spend” the calories taken in. Let’s say we take in 2000 calories; some will be used for the energy we need during a 24-hour period by our body during resting conditions (Basal Energy Expenditure) and some will be used to synthesize muscle, bone or other proteins.  “Calories out” is not just exercise.

Another underlying assumption is that all calories are created equal. But are they? First what is a calorie?

A calorie is the amount of heat that is released when certain foods are burned in a laboratory.  It doesn’t matter if the food is protein, fat or carbohydrate, if they have 100 calories then 100 calories of heat is released when they are burned. So in the “calorie in, calorie out” model it really doesn’t matter what we eat whether it is broccoli or butter, in the end it only matters how many calories they add up to.  Period.

If we start with the assumption that “calories in” are independent of “calories out” then the only thing that really matters is how many calories we take in, not from what sources. In this model, since all food is burned and a certain amount of calories are released, then we arrive at the conclusion that weight gain is simply a matter of comparing what goes in (energy) to what goes out (energy expenditure).  In this simplistic view, weight gain is caused by having too many calories (energy) compared to too little exercise (energy expenditure).  But it is not that simple.

Some of the energy expenditure will be for building tissue, staying warm, cognitive function and our bodies determine whether “calories in” go to those involuntary functions over voluntary exercise Looking at weight loss in terms of the “calorie in, calorie out” model fails to take into account that the body will slow its metabolism in response to reduced calories, because it needs to use those calories for vital functions so restricting calories doesn’t necessarily translate to weight loss.

Furthermore, assuming that all foods can be boiled down to how many calories they contain fails to take into consideration that the composition of different types of foods actually increases or decreases hunger and thus eating when and what and how much we eat. The assumption by many health care professionals has been that obese people are overweight because their metabolism has slowed and that keeps them from burning off the calories they take in.

To explain this in terms of the “calories in calories out” model, say a slim person takes in 2000 calories and has a Total Energy Expenditure (TEE) [the amount of calories they burn per day] of 2000 calories, which means they don’t gain or lose weight. An obese person will take in the same 2000 calories, but assuming their TEE is lower, say 1500 calories, 500 calories are store as fat and they gain a pound. But is that in fact so?

A recent study however has disproved this.

When measured in the laboratory, obese people had a Total Energy Expenditure (TEE) of 3244 calories compared to lean people who had a TEE of 2404 calories. That is, when excess calories are eaten in someone who is already obese, the body will actually increase its Basal Energy Expenditure (BEE) to try and get rid of those calories.

So why are obese people obese?

Shouldn’t this increase in Total Energy Expenditure over time caused them to burn off those calories and become lean again? Actually, body weight, like other functions in our body is a closely regulated system and we have so something called a “Set Point” which acts to regulate it. When too many calories are taken in, the body tries to get rid of them and when too few calories are taken in, the body tries to conserve them. The body does this to maintain its ‘set point’. So if we are overweight, the body will adjust its processes to maintain that set point. More on that below. It is not about how many calories we take in but what changes the Set Point.

People also make the assumption that how much we eat (“calories in”) is voluntary; that is we can choose to eat or not eat, but there are a number of hormones such as leptin, ghrelin, cholecystokinin, and peptin YY that tell our body when we are hungry and we are not. Hunger and satiety (feeling full) are under hormonal control and as such, when we eat (“calories in”) is not voluntary.

People also assume that ‘Calories Out’ is voluntary; that we control how much exercise we do and assuming that our basal energy expenditure is stable and unchanging over time, we ignore it.  But it is not. This mistaken belief that the only variable that changes is the energy expended in voluntary exercise and that this consumes a major proportion of our calories leads to the conclusion that “diet” and “exercise” are equal partners in weight management and they aren’t.

The fact is, most of our Total Energy Expenditure is used for generation of body heat and other metabolic processes (called Basal Energy Expenditure). Furthermore, Basal Energy Expenditure is not stable and can increase or decrease by as much as 50%. This up-regulation and down-regulation of our body processes contributes way more to weight loss or gain than exercise does. But that is not what we’ve been told.  We have believed that if we just exercise more and eat less we will lose weight. Let’s look at this a little more closely.

What happens to our body if we suddenly restrict caloric intake? According to “calories in calories out” model, a reduction in calories will result in Total Energy Expenditure (TEE) using fat for energy and the person would lose weight.  Sounds great except that is not what happens.

In fact, Total Energy Expenditure drops substantially – by as much as 30-50%.  People complain of being unable to stay warm even with plenty of clothing and that is because calories are spared in heating the body. Heart rate and blood pressure drop to conserve energy (calories).  People even find it difficult to concentrate because the brain is very metabolically active and restricting calories suddenly turns that down. Calories are needed to move, so in sudden calorie restriction people feel weak during physical activity. In other words, metabolism slows.

Why does the body do this? It’s survival.

Consider a person normally eating 3000 calories a day suddenly starts eating 2000 calories a day.  If they were to continue to burn 3000 calories daily, they would soon deplete all their fat stores, then their protein stores and then they would die. The body tightly regulates body weight and compensates for this sudden decrease in calories by saving calories from its Total Energy Expenditure.  Instead of burning fat in storage, the body reduces its caloric expenditure on body functions to 2000 calories a day and restores balance.

The “calorie in calorie out” model does not factor in that basal energy expenditure is not stable.  It ignores that restricting calories results in down-regulation in Total Energy Expenditure. That is, “calories in” and “calories out” are not independent.

The “calorie in calorie out” model of weight gain also ignores that hunger, eating and fat storage are regulated by numerous hormones. Leptin (a hormone correlated to the amount of body fat) is one such mechanism, adiponectin (a hormone suppressed in obese people) may be another mechanism and there are others being researched.  It is also believed that cortisol, the stress hormone may play a role.  But there is one well-known hormone that plays a very significant role in hunger, eating behavior and fat management and that is insulin. Insulin’s effect will be covered in detail in future blogs. A little ‘teaser’; we as health care practitioners have been focusing on blood glucose while overlooking insulin, which regulates it.

So in summary,

  1. “calories in” and “calories out” are not independent, but one affects the other.
  2. “Calories in” is not only under voluntary control (what and how much we choose to eat) but several hormone play a significant role in terms of hunger and fat storage.
  3. “Calories out” is not only controlled voluntarily through exercise but also involuntarily by up-regulating and down-regulating basal metabolic expenditure (tissue synthesis, heat generation, etc).
  4. Fat storage is not simply a result of having more “calories in” than “calories out” burned as exercise.

So what causes us to gain weight? This will be the topic of future blogs.

REFERENCES

DeLany J P, Kelley D E, Hames K C et al, High energy expenditure masks low physical activity in obesity, International Journal of Obesity 37, 1006-1011 (July 2013)

Fung, Jason, Intensive Dietary Management, The Aeteology of Obesity, August 2013

Health Canada, Overweight and Obese Adults (2102), http://www.statcan.gc.ca/pub/82-625-x/2013001/article/11840-eng.htm

 

Copyright ©2015 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this website, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 

Feel free to share!